What is the recommended tapering regimen for a patient who has been on quetiapine (quetiapine) 25mg for many years and wishes to discontinue the medication?

From the Guidelines

A gradual tapering approach is recommended for discontinuing quetiapine 25mg after long-term use, with a reduction of 25-50% every 2-4 weeks, to minimize the risk of withdrawal symptoms and rebound effects. The patient should reduce the dose by 25-50% every 2-4 weeks, which in this case would mean cutting the 25mg tablet in half to 12.5mg for 2-4 weeks, then taking 12.5mg every other day for 2-4 weeks before stopping completely. This entire process typically takes 1-2 months. During tapering, patients should monitor for withdrawal symptoms such as insomnia, nausea, headache, dizziness, irritability, or return of original symptoms. The slow tapering is necessary because abrupt discontinuation can lead to rebound effects and withdrawal symptoms due to the body's adaptation to the medication over years of use. Even at this low dose, quetiapine affects multiple neurotransmitter systems including dopamine, serotonin, and histamine receptors, and the brain needs time to readjust to functioning without the medication. Patients should maintain regular communication with their healthcare provider throughout this process, as the tapering schedule may need adjustment based on individual response.

Some key points to consider when tapering quetiapine include:

• The tapering schedule should be individualized based on the patient's response and medical history 1
• A slower taper may be necessary for patients who have been taking quetiapine for a longer period of time 1
• Patients should be monitored closely for withdrawal symptoms and rebound effects during the tapering process 1
• The use of alternative therapies, such as cognitive behavioral therapy, may be beneficial in managing withdrawal symptoms and improving treatment outcomes 1

It's also important to note that the evidence provided is primarily related to opioid tapering, and the application of these principles to quetiapine tapering should be done with caution and under the guidance of a healthcare professional. However, the general principles of gradual tapering and individualized treatment plans can still be applied to quetiapine tapering.

From the FDA Drug Label

Although there are no data to specifically address re-initiation of treatment, it is recommended that when restarting therapy of patients who have been off quetiapine fumarate tablets for more than one week, the initial dosing schedule should be followed

The FDA drug label does not answer the question.

From the Research

Tapering Regimen for Quetiapine

The recommended tapering regimen for a patient who has been on quetiapine 25mg for many years and wishes to discontinue the medication is not explicitly stated in the provided studies. However, some general guidelines can be inferred:

• Gradual withdrawal is often recommended to minimize withdrawal symptoms 2.
• Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms 3.
• Exponential tapering programs that reach very small doses may be effective in reducing withdrawal symptoms 3.

Considerations for Quetiapine Dependence and Withdrawal

Quetiapine dependence and withdrawal have been reported in some cases 4. Therefore, it is essential to be cautious when discontinuing quetiapine, especially in patients with a history of substance abuse.

• Quetiapine has a mean terminal half-life of approximately 7 hours, and its primary route of elimination is through hepatic metabolism 5.
• The pharmacokinetics of quetiapine do not appear to be altered by cigarette smoking, but oral clearance declines with age 5.

Successful Discontinuation of Antipsychotic Medication

Some studies suggest that it is possible to successfully discontinue antipsychotic medication, including quetiapine, with a gradual withdrawal method 2.

• Withdrawing gradually across more than one month was positively associated with self-defined successful discontinuation and no current use 2.
• Relapse during withdrawal presents a major obstacle to successfully stopping antipsychotic medication, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal 2.