What is the recommended taper schedule to discontinue quetiapine (Seroquel) 12.5 mg taken at bedtime?

Discontinuing Quetiapine 12.5 mg at Bedtime

For a patient taking quetiapine 12.5 mg at bedtime—a dose far below the therapeutic range for psychiatric indications—abrupt discontinuation is generally safe and does not require a formal taper. 1

Why This Dose Does Not Require Tapering

• Quetiapine 12.5 mg is a subtherapeutic dose used off-label for insomnia, representing only 4% of the minimum FDA-approved antipsychotic dose (300 mg/day for schizophrenia) 2, 3
• At this dose, quetiapine functions primarily as a sedative-hypnotic through antihistamine (H1) blockade rather than dopamine receptor antagonism, making withdrawal phenomena extremely unlikely 2, 4
• The half-life of quetiapine is approximately 6 hours, meaning the drug clears the system within 24–30 hours after the last dose, minimizing any physiological dependence 2, 3

Recommended Discontinuation Approach

Simply stop the medication without tapering. 1

If You Prefer a Conservative Approach

For patients anxious about stopping or who have taken the medication for many months, you may offer:

• Week 1: Take 12.5 mg every other night (3–4 doses total)
• Week 2: Discontinue completely

This "psychological taper" provides reassurance but is not medically necessary at this dose. 5

What to Expect After Stopping

• Rebound insomnia may occur for 2–5 nights, representing the return of the original sleep difficulty rather than true withdrawal 4, 6
• No risk of seizures, delirium, or serious withdrawal syndromes that characterize benzodiazepine or antipsychotic discontinuation at therapeutic doses 1, 5
• Patients may experience transient difficulty falling asleep, which typically resolves within one week as natural sleep architecture re-establishes 4

Non-Pharmacologic Sleep Support During Transition

• Implement cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment, which has superior long-term outcomes compared to any medication 5, 4
• Optimize sleep hygiene: consistent bed/wake times, limit screen exposure 1 hour before bed, cool dark bedroom, avoid caffeine after 2 PM 1
• Consider time-limited use of melatonin 3–5 mg at bedtime for 1–2 weeks if rebound insomnia is distressing 1

Critical Safety Considerations

• Do NOT substitute another sedative-hypnotic (benzodiazepines, zolpidem, trazodone) as this perpetuates medication dependence and carries its own risks 1, 5
• Avoid long-term quetiapine for insomnia due to metabolic risks (weight gain, diabetes, dyslipidemia) that persist even at low doses 7, 6
• Monitor for return of underlying psychiatric symptoms (anxiety, depression) that may have been masked by the sedating effect 4

When to Refer or Reconsider

• If insomnia persists beyond 2 weeks after discontinuation, evaluate for primary sleep disorders (sleep apnea, restless legs syndrome, circadian rhythm disorders) or untreated psychiatric conditions 1
• If the patient has been taking quetiapine for a diagnosed psychiatric condition (bipolar disorder, schizophrenia, major depression), coordinate discontinuation with their psychiatrist, as even low doses may provide some mood stabilization 2, 3

Common Pitfalls to Avoid

• Do not overthink this decision—12.5 mg quetiapine is pharmacologically closer to diphenhydramine (Benadryl) than to an antipsychotic at therapeutic doses 2, 4
• Do not apply antipsychotic tapering protocols designed for doses of 300–800 mg/day, which carry genuine risks of dopamine supersensitivity and withdrawal dyskinesias 1, 2
• Do not continue quetiapine indefinitely "because it works"—the metabolic and cognitive risks accumulate over time, and tolerance develops within weeks 7, 6