What is the recommended tapering schedule for discontinuing 100mg of Seroquel (quetiapine)?

Tapering Quetiapine (Seroquel) 100mg

For quetiapine 100mg, reduce the dose by 25mg every 2 weeks until reaching 25mg, then consider switching to 25mg every other day for 2 weeks before discontinuation. 1

Recommended Tapering Schedule

Gradual dose reduction over 6-8 weeks minimizes withdrawal symptoms and prevents symptom relapse. 1, 2

Specific Tapering Protocol:

• Week 1-2: Reduce from 100mg to 75mg daily 1
• Week 3-4: Reduce from 75mg to 50mg daily 1
• Week 5-6: Reduce from 50mg to 25mg daily 1
• Week 7-8: Take 25mg every other day for 2 weeks 1
• Week 9: Discontinue completely 1

This schedule represents a 25mg reduction every 2 weeks, which is appropriate for the relatively low starting dose of 100mg. 1

Critical Monitoring Requirements

Schedule follow-up appointments every 2-4 weeks during the taper to assess for withdrawal symptoms and symptom recurrence. 2

Watch for Withdrawal Symptoms:

• Insomnia, anxiety, irritability, nausea, dizziness, and headache are common withdrawal symptoms. 1, 3
• If withdrawal symptoms occur, return to the previous well-tolerated dose and slow the taper further. 1, 2
• Consider adjunctive medications for specific withdrawal symptoms (e.g., trazodone for insomnia). 1

Monitor for Symptom Relapse:

• Document baseline symptoms before initiating the taper to identify any return of original psychiatric symptoms. 2
• Patients with psychiatric disorders may experience symptom return weeks to months after dose reduction. 2
• If original symptoms return, consider temporarily returning to the previous dose before attempting a smaller reduction (e.g., 12.5mg decrements). 2

Important Contraindications to Rapid Tapering

Abrupt discontinuation of quetiapine is considered unacceptable medical care and can trigger significant withdrawal symptoms. 2

• Never stop quetiapine suddenly—this can cause severe withdrawal and symptom rebound. 2
• Patients on long-term therapy (months to years) require slower tapers than those on short-term treatment. 1, 3
• If the patient has been on 100mg for an extended period, consider extending each dose reduction interval to 4 weeks instead of 2 weeks. 1

Managing Complications During Tapering

If severe withdrawal symptoms develop, immediately return to the previous dose and implement a more gradual taper with smaller dose reductions (12.5mg instead of 25mg). 1, 2

Adjusting the Taper:

• For patients who cannot tolerate 25mg reductions, use 12.5mg reductions every 2-4 weeks. 2
• Extend the time between dose reductions to 4-6 weeks if needed. 2
• Each new dose should be maintained until the patient is stable before proceeding to the next reduction. 1

Special Considerations

Quetiapine has a relatively short half-life of approximately 7 hours, which may contribute to withdrawal symptoms if tapered too quickly. 4

• The sedating effects of quetiapine mean withdrawal insomnia is particularly common. 1
• Quetiapine's low propensity for extrapyramidal symptoms means withdrawal movement disorders are unlikely. 5, 6
• Avoid "cold referrals" to other clinicians during the taper—maintain continuity of care throughout the discontinuation process. 2

Common Pitfalls to Avoid

• Do not taper faster than 25mg every 2 weeks for a 100mg starting dose. 1
• Do not skip the "every other day" dosing phase before complete discontinuation. 1
• Do not discontinue follow-up appointments prematurely—symptoms may emerge weeks after the final dose. 2
• Do not ignore early withdrawal symptoms hoping they will resolve—they typically worsen without intervention. 1