Seroquel too strong?

TooEarly

The doc recently prescribed it. My DW is small framed, which is perhaps a factor. But the first day she took it at breakfast - wham! - she fell asleep 2 hours later, woke up for 2 hours, then out (hard) again.

I called the physician, said cut the pill in half tomorrow. I will try it but am still worried this will be too much for her.

At the same time, the reason it was prescribed is she had reached the point of becoming more antsy and a little agitated. She'd been fairly upbeat until the last few months. Stage? I'm guessing 6. Any input appreciated.

midge333

My DW is also a small woman. She was started on 25 mg once a day and then rapdidly increased to 25 mg twice a day. It initially made her sleepy but she rapidly acclimated to it. She is now on 75 twice a day. I think starting with a half dose is a great idea.

M1

Welcome to the forum Too Early. I think the suggestion to cut in half is a good one and you can also give it in the evening with dinner or bedtime, it should help her sleep through the night. Depending on how she responds the next day or so you could add a morning dose (also 12.5) but only if she needs it.

​fesk

Starting at a lower dose is a good idea and the side effects may lessen in time. Also, was the anxiety/agitation mild? Were other medications considered - antidepressant etc., before an antipsychotic?

TooEarly

Fesk, compared to other examples I've read, I'd say her anxiety/agitation would be mild. Nothing out of control or fully hostile.

M1, she has been sleeping really well through the night prior to this medication. In fact, I specifically told the doc this and said I don't want anything to mess up her sleep (because bedtime is the one thing I can count on). She sometimes wakes around 3 a.m., goes to the bathroom and goes right back out.

Joe C.

The first time I gave DW 25 mg of seroquil it really knocked her out. Her Dr. had the same recommendation, cut the pill in half. The half pill still made very sleepy but she acclimated to it in about two weeks. Over time we had to increase her dosage but she continued to do well on medication. It was really a lifesaver due to the delusions she was having.

TooEarly

Thanks, Joe. We're still within that first 2-week period. She seems to get sleepy 60-90 minutes after taking it. One day, a cleaning person came over so she missed that nap and though she slept a bit later in the afternoon, it seemed like a harder day. So for now, I'm going to try to not to interfere with the early nap.

Denise1847

https://alzconnected.org/discussion/comment/223371#Comment_223371

https://alzconnected.org/discussion/70615/seroquel-too-strong

My DH is on Seraquel and it has really helped to calm him. It took awhile to get the right dosage, but it is so much better for him and I.

TooEarly

I have an older friend whose wife has ALZ. He told me the neurologist told him to administer 1/2 pill when symptoms occur — not daily automatically.

Anyone else hear of this? Or going this route?

TooEarly

Still knocking DW out for part of the day — and putting her in a deep fog right before and after in which she is really agitated and wants to "get out of here." This recedes later.

Anyone have experience with an alternative drug that doesn't make the person take a long, hard nap?

M1

Have you tried dosing it just at night?

​fesk

I'd recommend discussing with the doctor. If her anxiety and agitation are truly mild as you mentioned above, an antipsychotic may not be needed. If you stick with antipsychotics, there are several choices. Everyone reacts differently, so it will be trial and error. Also, you may not be able to avoid the side effect of it making her tired, but you may be able to minimize it.

harshedbuzz

https://alzconnected.org/discussion/comment/223474#Comment_223474

I don't like this sort of approach apart from a situational anxiety (ahead of flying or an MRI), it feels too much like playing wack-a-mole if the anxiety/agitation is fairly consistent day-to-day. The whole point of the meds is to prevent those big feelings.

HB

TooEarly

https://alzconnected.org/discussion/comment/225114#Comment_225114

She sleeps really really well now - 9 hours minimum. I would be concerned about messing that up, if it is a possibility.

M1

no, it shouldn’t mess it up, and it might make her less sleepy in the daytime. I would encourage you to try it.

BPS

My wife has delusions and has been taking 5mg of Donepezil for 8 years but the dr just raised it to 10 mg for to try and help the delusions.

BPS

M1

Bps I don't think donepezil will make one whit of difference. Is it time to ask for geriatric psych referral?

TooEarly

Thanks for all the input. In no particular order:

— @M1 what could a geriPsych do beyond what the neurologist is doing? I guess I'm not familiar.

— Had a long talk w/ the neurologist a few days ago. She thinks the behaviors I describe (I haven't given y'all as much detail as her b/c I don't want to run on and on), sound like ALZ progression (regression?) rather than just anxiety; we are hitting severe stage and it is moving faster w/ us than typical.

Said I can't do both at once and if I switch to anti-anxiety it might take 3 weeks to really kick in and see if that was the right call. Damned if I do, damned if I don't. So I said let's not switch now. Anecdotally, a friend just last night told me of a friend of his who was switched to anti-anxiety and it really backfired. Just one word of mouth case, I know, but still.

— Has anyone else switched from a daytime dose to a bed-time dose? What was your experience with the transition?

— We're doing 12.5mg — DW is slight and any drugs/alcohol always seem to hit her quickly. Has anyone switched from 12.5 to 25 and what was your experience with the transition?

Thanks, everyone.

TooEarly

https://alzconnected.org/discussion/comment/226028#Comment_226028

Also, if it makes a difference, my DW is in her mid-60s.

As I might have mentioned previously, it's early-onset and we've been dealing with it about 6-7 years if you start counting with MCI.

M1

I have no idea what the doc means saying they "can't do both at once"-- of course you can, many people are treated with an SSRI like citalopram, escitalopram or sertraline for anxiety in addition to an atypical antipsychotic. My partner is on both in addition to low dose Ativan, which has helped a lot. This neurologist doesn't sound very experienced and again I would absolutely push for a geriatric psych referral.