Tapering Off 100 mg of Seroquel (Quetiapine)
For a patient on 100 mg of quetiapine, reduce the dose by 10-25% of the current dose every 1-2 weeks, which means starting with a reduction to 75-90 mg for the first 1-2 weeks, then continuing to reduce by 10-25% of each new lower dose until complete discontinuation is achieved over a minimum of 2-4 months. 1
Recommended Tapering Protocol
Initial Approach
Begin by reducing from 100 mg to 75-90 mg (a 10-25% reduction) for the first 1-2 weeks, monitoring closely for withdrawal symptoms 1. The reduction should always be calculated as a percentage of the current dose, not the original dose, to prevent disproportionately large final reductions 1.
For patients who have been on quetiapine for more than 1 year, slow the taper to 10% of the current dose per month rather than every 1-2 weeks to minimize withdrawal symptoms 1.
Step-by-Step Tapering Schedule Example
For a patient on 100 mg daily (assuming use less than 1 year):
- Weeks 1-2: Reduce to 75-80 mg daily (20-25% reduction) 1
- Weeks 3-4: Reduce to 60-65 mg daily (20% of current dose) 1
- Weeks 5-6: Reduce to 48-52 mg daily (20% of current dose) 1
- Weeks 7-8: Reduce to 38-42 mg daily (20% of current dose) 1
- Weeks 9-10: Reduce to 30-34 mg daily (20% of current dose) 1
- Weeks 11-12: Reduce to 24-27 mg daily (20% of current dose) 1
- Once you reach the smallest available dose (typically 25 mg tablets), extend the interval between doses (e.g., every other day, then every third day) before complete discontinuation 1.
Critical Tapering Principles
The taper rate must be determined by the patient's tolerance, not a rigid schedule—pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge 1.
Never use straight-line percentage reductions from the starting dose (e.g., reducing by 10 mg every week), as this creates disproportionately large reductions at lower doses and increases withdrawal severity 1.
Abrupt discontinuation of quetiapine is never appropriate and can lead to severe withdrawal symptoms including insomnia, nausea, anxiety, and rarely seizures 1.
Monitoring for Withdrawal Symptoms
Common Withdrawal Symptoms to Watch For
Monitor for anxiety, irritability, insomnia, dizziness, headache, nausea, mood changes, and flu-like symptoms at each dose reduction 2.
Additional symptoms may include tremor, sweating, tachycardia, weakness, muscle aches, and confusion 1.
If clinically significant withdrawal symptoms occur, immediately return to the previous dose and slow the taper by either increasing the interval between reductions (e.g., every 3-4 weeks instead of 1-2 weeks) or decreasing the amount of dose change (e.g., 10% instead of 25%) 1.
Follow-Up Schedule
Follow up with the patient at least monthly during the taper, with more frequent contact (weekly or biweekly) during difficult phases 1.
Screen for unmasked anxiety, depression, or other psychiatric conditions that may emerge during tapering, and distinguish these from withdrawal symptoms 2.
Adjunctive Strategies to Manage Withdrawal
Pharmacological Support
For insomnia during the taper, consider trazodone 25-50 mg at bedtime for short-term management 2.
For anxiety, irritability, and sensory symptoms, consider gabapentin 100-300 mg daily, starting at the lower end and titrating as needed 2.
For nausea, antiemetics can be used as needed 1.
Non-Pharmacological Support
Integrate cognitive-behavioral therapy (CBT) during the taper, as this significantly increases success rates 1.
Provide patient education about potential withdrawal symptoms and the benefits of gradual tapering to improve outcomes and engagement 1.
Additional supportive measures include mindfulness and relaxation techniques, sleep hygiene education, and exercise 1.
Special Considerations and When to Refer
High-Risk Patients Requiring Specialist Referral
Patients with a history of withdrawal seizures should be referred to a specialist rather than managed in primary care 1.
Patients with unstable psychiatric comorbidities require specialist involvement 1.
Patients with co-occurring substance use disorders should be referred to a specialist 1.
Cases where office-based tapering has been unsuccessful should be referred to a specialist 1.
Special Populations
For elderly patients, consider a more gradual taper with smaller dose reductions (e.g., 10% every 2-3 weeks) to minimize adverse effects 1.
Pregnant patients should not taper quetiapine without specialist consultation, as withdrawal can cause complications 1.
Critical Pitfalls to Avoid
Never abandon the patient, even if tapering is unsuccessful—maintain the therapeutic relationship and consider maintenance therapy at a lower dose if complete discontinuation proves intolerable 1.
Never taper too quickly—research shows that rapid tapers (e.g., 10% reduction every 3 days) result in only 24% of patients completing withdrawal successfully 1.
Do not substitute another sedating medication (such as benzodiazepines or Z-drugs) during the taper, as this simply transfers dependence 1.
Realistic Timeline and Expectations
The taper will likely take a minimum of 2-4 months, and possibly 6-12 months or longer for patients on quetiapine for extended periods 2.
Success is measured by durability and tolerability, not speed—tapers may be considered successful as long as the patient is making progress 1.
Patient agreement and interest in tapering is a key component of success—use shared decision-making and explain the risks of continued use versus benefits of discontinuation 1.