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Dear Dr. G - Quetiapine Question
mercygive posted:
Dear Dr. G,

During the past several months I have noticed that I wait 2-3 hours before I can fall asleep after taking Quetiapine. It used to knock me out within 15-30 minutes and I would get at least 8 hours solid rest. I still want that benefit. The dosage has not changed and I have finally come to the place where I enjoy not having to take it so early in the evenings to avoid hangovers in the mornings.

I have read that Quetiapine is not addictive, but can my body build up a tolerance to where the dosage needs to be increased? Also, since I am taking the generic would that make a difference?

Thank you very much
A little yoga goes a long way
Joseph F Goldberg, MD responded:
Dear mercygive,

Quetiapine is an antipsychotic, antimanic and antidepressant drug that has a potent antihistamine (Benadryl-like) effect, which is what causes sedation as a side effect. It is not meant to be a sleeping pill but some doctors describe it to their patients as if that were its intended purpose. It is thought that over time people can become tolerant to the antihistamine side effects of a medicine (the same as if you took Benadryl every days for many weeks or months), once the histamine receptor has been totally saturated, making the side effects of sedation less troublesome or prominent. The side effect of sedation has not been shown to be dose-related in studies done by the manufacturer. Time till onset of the antihistamine effects is possibly more rapid with quetiapine than with the XR formulation, but the degree and amount of sedation as a side effect between the two forms of Seroquel haven't been shown to differ.

It sounds like that success may have come your way in overcoming the antihistamine side effect. If there is a separate need for a sleep aid, then you and your doctor might discuss the role for medicines that are more properly sleep aids, such as GABA-A agonists, benzodiazepines, melatonin/Rozerem, etc.

Dr. G.
mercygive replied to Joseph F Goldberg, MD's response:
My doctor did prescribe Quetiapine for its intended purposes and the sedation came as an added value. It makes sense what you said about the 'like' antihistamine sedation diminishing over time.

I favor natural remedies so I will try Melatonin. Do you know if GABA supplement is a good substitute and would it interfere with using Benzodiazepines and/or GABA-A agonists (Ambien, Lunesta)? I did not see any interactions on the product review.

Thank you again for your time.
A little yoga goes a long way
Joseph F Goldberg, MD replied to mercygive's response:
Dear mercygive, Oral GABA pills from the health food store don't cross the blood brain barrier, so the product makes money for the manufacturer but doesn't do much else. Dr G
eeyorecrew replied to Joseph F Goldberg, MD's response:
I take 200-600mg of Quetiapine at night, along with 10mg of Ambien, 100mg of Lamictal, and 10mg of Valium. That does the trick for a solid 8 hours sleep.....I typically take 400mg of the Quetiapine at bedtime, but 600 if in mania.

I replace ambien with a Zinc-Magnesium supplement when I don't really feel like I need the Ambien. It's called "ZMA" and I discovered it years ago as a body-building supplement, and discovered that a side effect was good sleep...but I digress....

I agree with the doc that if the Quetiapine isn't doing the trick, then they may want to try a more targeted "sleep" med in addition to the Quetiapine....also, if you take the XR, you're supposed to take it like 4 hours before bed, whereas with the regular, non-XR, you take it at bedtime...

That's my two cents. Oh wait, I've tried those meds the Dr. mentioned, and although they worked for a while, I never had any luck with them on an extended basis. However, my dad takes Rozerem, and has pretty good luck with it. I guess it all depends a lot on what other medicines you may take for other stuff....I take about 11 prescription meds, plus I have a morphine pain pump, so I'm pretty maxxed out on stuff.

Even so, I still get manic, and when I do, my doc told me to take the higher dosages I mentioned earlier....those being:
1. 600mg Quetiapine
2. 10mg Ambien
3. 100mg Lamictal
4. 10mg Valium (I take this 2-3 times per day, plus bedtime when manic)

Okies, hope this is of some help.

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