How do I safely stop taking Quetiapine (Seroquel) 25mg?

Stopping Quetiapine 25mg

If you need to stop quetiapine 25mg, do not discontinue it abruptly—taper gradually to avoid withdrawal symptoms including insomnia, nausea, and vomiting. 1

Tapering Protocol for Low-Dose Quetiapine

Why Gradual Tapering is Essential

• Abrupt discontinuation can cause withdrawal symptoms such as trouble sleeping, insomnia, nausea, and vomiting, as warned by the FDA label 1
• Severe withdrawal syndromes with nausea and vomiting have been documented even at low doses when quetiapine is discontinued too rapidly 2
• Neuroadaptations from antipsychotic exposure can persist for months after stopping, potentially causing rebound symptoms if tapered too quickly 3

Recommended Tapering Approach

For a 25mg dose, use a hyperbolic tapering schedule where you reduce by a fraction of the most recent dose (not the original dose), making progressively smaller reductions as you approach zero 3:

• Start by reducing to approximately 18-19mg (about 25% reduction from 25mg) and maintain this for 3-4 weeks 3
• Next reduce to approximately 13-14mg (25% of the 18mg dose) and maintain for another 3-4 weeks 3
• Continue reducing by 25% of the current dose every 3-4 weeks until reaching very small doses 3
• Final doses before complete cessation may need to be as small as 1-2mg to prevent a large change in receptor blockade when stopped entirely 3

Alternative Faster Taper

Some patients may prefer a more rapid taper of 10% of the most recent dose each month, though this carries higher risk of withdrawal symptoms 3. Given you're on a low dose of 25mg, a conservative approach over 2-3 months is safer.

Practical Considerations

• Quetiapine has a short half-life of approximately 6 hours, which means withdrawal symptoms can emerge quickly after missed doses 4, 5
• The medication is only available orally, so you'll need to work with your prescriber to obtain appropriate lower-dose tablets or consider splitting tablets if feasible 6
• Monitor for withdrawal symptoms including insomnia, anxiety, nausea, vomiting, and agitation during the taper 1, 2

Managing Withdrawal Symptoms

• If severe nausea and vomiting occur during tapering, pretreatment with an antiemetic like domperidone may help, as demonstrated in case reports 2
• Slow or pause the taper if withdrawal symptoms become intolerable—the rate must be determined by your tolerance, not a rigid schedule 3
• Contact your healthcare provider immediately if you experience severe symptoms that don't resolve with slowing the taper

Special Monitoring

• Since quetiapine can cause small decreases in thyroid hormone levels, these typically reverse with treatment cessation 4
• Asymptomatic liver enzyme elevations associated with quetiapine usually resolve after discontinuation 4

Critical Warning

Never stop quetiapine suddenly on your own—always work with your prescriber to develop an individualized tapering schedule based on how you tolerate each dose reduction 1. At 25mg, you're on a relatively low dose, but the principles of gradual tapering still apply to minimize withdrawal risk.