What is the recommended protocol for weaning off Seroquel (quetiapine)?

Recommended Protocol for Weaning Off Quetiapine (Seroquel)

The recommended protocol for weaning off quetiapine is a gradual taper of 10% of the original dose per week to minimize withdrawal symptoms, with slower tapering once reaching lower doses. 1

Assessment Before Tapering

• Evaluate the patient's current dose, duration of use, and reason for discontinuation 2
• Screen for risk factors that may complicate withdrawal, such as history of psychiatric disorders, previous withdrawal symptoms, or concurrent medications 1
• For patients taking quetiapine for less than 7 days, discontinuation can generally occur more quickly with minimal risk of withdrawal symptoms 3
• For patients taking quetiapine for 7-14 days, a more structured but relatively quick taper is needed 3
• For patients taking quetiapine for more than 14 days, a more gradual tapering protocol is required to minimize withdrawal symptoms 3

Tapering Protocol

For Short-Term Use (< 7 days)

• May reduce dose by 25-50% every 1-2 days with monitoring for withdrawal symptoms 3

For Intermediate Use (7-14 days)

• Reduce dose by 20% every 2-3 days 3
• Example: If taking 300mg daily, reduce to 240mg for 2-3 days, then 180mg for 2-3 days, etc.

For Long-Term Use (> 14 days)

• Reduce dose by 10% of the original dose per week 1
• For example, if taking 400mg daily:
  • Week 1: 360mg daily
  • Week 2: 320mg daily
  • Week 3: 280mg daily, and so on 1
• Once reaching lower doses (typically 50-100mg), slow the taper further to 5% reductions per week 1
• If on twice-daily dosing, maintain the same dosing schedule during tapering 2

Monitoring During Tapering

• Monitor for withdrawal symptoms including nausea, vomiting, insomnia, anxiety, irritability, headache, dizziness, and potential rebound psychosis 4
• If severe withdrawal symptoms occur, pause the taper and maintain the current dose for an additional week before resuming the taper at a slower rate 1
• Consider using antiemetics like domperidone for managing nausea and vomiting during withdrawal if these symptoms are severe 4
• For patients with bipolar disorder or schizophrenia, monitor closely for symptom recurrence during the tapering process 5

Special Considerations

• For elderly patients, use a slower rate of dose reduction (5% per week) due to increased sensitivity to medication changes 2
• Patients with hepatic impairment may require even more gradual tapering due to altered drug metabolism 2
• If a patient is taking other psychotropic medications, consider tapering one medication at a time rather than simultaneously 3
• For patients on high doses (>600mg daily), consider a longer initial stabilization period at each dose reduction 2, 6

Managing Complications

• If withdrawal symptoms become intolerable, return to the previous well-tolerated dose and resume tapering at a slower rate 1
• Avoid abrupt discontinuation as it significantly increases the risk of withdrawal symptoms and potential relapse 6
• If a patient experiences rebound insomnia, consider temporary use of non-benzodiazepine sleep aids rather than increasing quetiapine dose 1
• For patients who have been on quetiapine for more than a year, the entire tapering process may take several months to complete safely 1, 6

Follow-Up

• Schedule regular follow-up appointments during the tapering process to monitor progress and adjust the taper as needed 1
• Once quetiapine is completely discontinued, follow up within 2-4 weeks to ensure stability and absence of delayed withdrawal symptoms 1