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  1. 1. Did XR or IR Seroquel make you more tired

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    • IR
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Hi everyone,

I've been wondering about people's experience who have been on both the immediate release and extended release version of Seroquel. I have only tried the IR, and it knocked me out at doses from 25mg-100mg and when i woke up it felt so impossible to get out of bed and get ready for the day, then the rest of the day was alright as long as I took my ADHD medication. My current problems are under control, for the most part, I am just looking for other's who have had different experiences with the IR vs the XR version of Seroquel so that I can have insight if I need to consider treatment with quetiapine in the future. 

I'm mostly interested in the effectiveness to squash mania, the difference in sedation between the 2 different formulations and if anyone uses Seroquel on a PRN basis, for example only taking Seroquel when you are feeling manic and cannot sleep or feel mania coming on, please reply and let me know how this works and how your doctor feels about this treatment. If you do use it as PRN, do you use the XR or instant release formulation? I also am interested in anyone who takes ADHD stimulants with Seroquel and feels that the Seroquel makes their medication for ADHD less effective? I feel that my Rexulti may be making my Dexedrine and Zenzedi somewhat less effective and am considering getting off Rexulti if necessary and my pdoc agrees. Thanks for your replies!!

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I took 800 mg of IR Seroquel for many years. Then I had the "brilliant" idea to discontinue it with Dr approval within a week. Seroquel works wonders for mania prevention for me. Pretty much as long as I stay on it I don't get full blown "sent to the hospital" manic. It also helps my anxiety and psychosis. Anyway, I was on Abilify and Latuda in place of Seroquel IR. Guess what? I was hospitalized for mania and psychosis because of no Seroquel.

I was put back on Seroquel (but the XR version) while IP at 600 mg. Then my outpatient Dr increased it further back to 800 mg of the XR. 

There is a world of difference between the XR and the IR, IME. I am not sedated. I lost 30 lbs.  It's like a different but same med. 

I take nuvigil and in the past provigil with it and I find them to be effective with the Seroquel XR. 

I have never used it as a PRN. 

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Great to hear your experience, and how different the two formulations in terms of side effects. The main reason i am afraid to try XR is because I had such intense drowsiness with the regular version. I have never tried nuvigil or provigil, but am still having excessive daytime sleepiness despite taking my ADHD medication dexedrine. I will definitely bring up Seroquel XR to my doctor next time we meet. Thanks for your input @Wonderful.Cheese.

On a side note, how does Lunesta work for you? Does it work better, in your opinion, than Ambien?

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20 hours ago, mmaryland said:

Great to hear your experience, and how different the two formulations in terms of side effects. The main reason i am afraid to try XR is because I had such intense drowsiness with the regular version. I have never tried nuvigil or provigil, but am still having excessive daytime sleepiness despite taking my ADHD medication dexedrine. I will definitely bring up Seroquel XR to my doctor next time we meet. Thanks for your input @Wonderful.Cheese.

On a side note, how does Lunesta work for you? Does it work better, in your opinion, than Ambien?

Glad to help! I hope the you find the XR to have less side effects too. I really like it.

For me, lunesta works better than Ambien. To be fair I have only taken Ambien while IP though. For some reason the Dr liked Ambien over lunesta. That seems dumb if you ask me. Lunesta works fine for me, so why change that? I felt more refreshed after lunesta than I did after Ambien. But again I was IP and sleeping is difficult while IP. So maybe I'm not being fair.

I used to take trazodone and was on that for many years before the lunesta. I don't have a tired hangover after lunesta but I did with trazodone in the morning. 

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  • 2 weeks later...

I've taken both, and taken the two at the same time.

The XR was given to me as an add-on antidepressant. I think I was taking 250 mgs a day. It worked well for that, and thinking back I didn't have any noteworthy hypomanias, let alone manias, while I was on it. I took it in the morning and did not find it sedating. 

At the same time, I took 50-100 mgs of the IR at bedtime, in conjunction with Ambien CR, and that did make me sleepy. 

And yes, I have a bottle of 100 mg IR's on hand, and I have standing orders to start shoveling them down if I feel a mania coming on. I also occasionally take 25 mgs for anxiety or agitation.

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7 hours ago, BrianOCD said:

I tried the XR for a time and it was awful to me. Didn't feel nearly the same or effective as the IR...

YMMV

In what particular ways was it not as effective as IR formulation? I have heard this said a lot about ir vs xr seroquel but which aspect is lacking in XR than is there in the IR for you to feel its more effectiv?

 

6 minutes ago, Gearhead said:

I've taken both, and taken the two at the same time.

The XR was given to me as an add-on antidepressant. I think I was taking 250 mgs a day. It worked well for that, and thinking back I didn't have any noteworthy hypomanias, let alone manias, while I was on it. I took it in the morning and did not find it sedating. 

At the same time, I took 50-100 mgs of the IR at bedtime, in conjunction with Ambien CR, and that did make me sleepy. 

And yes, I have a bottle of 100 mg IR's on hand, and I have standing orders to start shoveling them down if I feel a mania coming on. I also occasionally take 25 mgs for anxiety or agitation.

Glad to hear about your experience with Seroquel XR. It was controlling your mania and hypomania very without the daytime sedation. Sounds like a fairly good med to use in adjunct with lithium or depakote for bipolar patients whose symptoms persist despite already taking medication(s). It might be able to ward off the mania more consistently due to its XR form. Then when mania increases, keeping the XR dose the same, but using the instant release when you feel mania coming on, this might make it so that your relapse for a next episode is not for longer.3

I think being able to recognize when your mania is beginning leads to better treatment outcomes based on the patient. If you recognize you are becoming manic, you should talk with your doctor ASAP or take the medication prescribed to you for that purpose, or else you could end up in hypomanic or manic episode. And if one doesn't take their medications, this can also lead to further symptoms and issues. How you mentioned you "had standing orders to start shoveling them down if i feel mania coming on" I believe every doctor should do this with their patients

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Personally for me, The XR wasn't as good as the IR for sleep.

Also, when I took it at bedtime, the XR left me feeling foggy throughout the whole next day, and the IR didn't have that effect for me when I took it at night.

I tried both for sleep/anxiety......

Edited by CrazyRedhead
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Thanks for your replies! Seems like IR seroquel is preferred pretty much across the board to XR for sleep. Im glad you mentioned the effects XR has on you during the day @CrazyRedhead I was really searching for an answer to how XR feels during the day. As I said, I started this thread to gain information on which formulation is more effective for acute hypomania. Your responses helped me discuss with my doctor the benefits seroquel IR might have, and coincidently I experienced hypomania earlier this week and needed a prescription for seroquel IR. I am glad I chose to go with the IR because the results are consistent and predictable. Plus, I am on Rexulti so I felt I didn't need 2 antipsychotics in my system working around the clock. In the event I need relief with seroquel but don't want certain consequences, like excessive sleepiness, intense hunger feeling, drowsiness, etc., I will consider trying the XR version since everyone seems to mention that there are less of these side effects with XR. For now, I am sticking to the IR version and using it PRN during acute phases or beginnings of hypomania or mania.

6 minutes ago, Swamp56 said:

I have more daytime fatigue from XR than IR, and I find it's also harder to fall asleep unless I take it early in the evening.

Is the fatigue with XR constant, like all day long? I know IR gives me some fatigue in the morning but it wears off eventually. Could you define this fatigue as cognitively impairing? I definitely prefer an AAP which has minimal cognitive impairment side effects, hence me being on Rexulti. If the impairment is at bedtime, I am more comfortable and welcoming of this sedation and drowsiness as it calms my mania and allows me to sleep, however, what I don't want is for these feelings to persist through the day and impact my academic performance. So far, the seroquel IR has not done this and I am hoping for it to continue giving me minimal daytime cognitive impairments.

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49 minutes ago, mmaryland said:

Is the fatigue with XR constant, like all day long? I know IR gives me some fatigue in the morning but it wears off eventually. Could you define this fatigue as cognitively impairing?

No, I get random bouts of sleepiness in the morning and afternoon, but it isn't bad enough to impact my work. I will sometimes drink caffeinated stuff like coffee or a Monster and that helps. I'm not a good case study for XR though as I typically take it way too late in the evening.

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14 hours ago, mmaryland said:

In what particular ways was it not as effective as IR formulation? I have heard this said a lot about ir vs xr seroquel but which aspect is lacking in XR than is there in the IR for you to feel its more effectiv?

It's hard to describe exactly what the issue was...

All I can say is it felt like taking a totally different drug.  I felt miserable on the XR.  

The IR helped me eat and get sleep when my anxiety was at its worse, and was effective all the way into the next day, even at lower dosages.  The IR was effective for me, the XR did nothing.  Hard to pinpoint the exact problem though since it was more of a feeling.  The IR makes me more tired than the XR.

That's not to say the XR isn't effective for some people though.  I take Effexor XR and some people say they'd rather take the effexor IR.

Edited by BrianOCD
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I have taken both at different points in treatment.  I did gain a lot of weight on ER.  I liked it though for the good all day coverage.  I was not too sleepy as long as I took it early enough.

Then I went on Abilify and lost 30 lbs but the side effects were awful.  Twitching and tremor and drooling.

Now I am back on Seroquel IR, taking it late at night.  It is working fine and I manage to fall asleep before the hunger takes over.  

I am on a low dose of 200 mgs.  You really need to try both to find your best option.  It is expensive however. 

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2 hours ago, BrianOCD said:

It's hard to describe exactly what the issue was...

All I can say is it felt like taking a totally different drug.  I felt miserable on the XR.  

The IR helped me eat and get sleep when my anxiety was at its worse, and was effective all the way into the next day, even at lower dosages.  The IR was effective for me, the XR did nothing.  Hard to pinpoint the exact problem though since it was more of a feeling.  The IR makes me more tired than the XR.

That's not to say the XR isn't effective for some people though.  I take Effexor XR and some people say they'd rather take the effexor IR.

Understand what you mean by hard to describe, for me I have similar experience with xanax and xanax XR. While i was on the XR I still got panic attacks throughout the day and felt worse then when my pdoc put me on klonopin. With xanax I feel like a completely different person, in a positive way. They just felt different enough to feel like I was taking a different medication. I can see this being the case with seroquel as well. Xanax and Seroquel are both fast acting medications and have shorter half lives relative to the other drugs in its class, to which most of their effectiveness and characteristics are a result of.

I love the appetite seroquel IR gives me, but it never really did anything for anxiety IME. I do like the ability to take lower doses and still get desired effects, but I am learning that hypo or manic episodes require those higher doses in order to stabilize mania. If I take lower doses during these times I remain awake and sleeping is impossible, however, during times when I am not manic, 25mg or 50mg is more than enough, and most often I don't even have to resort to Seroquel because my usual Ambien is enough to help me fall asleep.

24 minutes ago, bpladybug said:

I have taken both at different points in treatment.  I did gain a lot of weight on ER.  I liked it though for the good all day coverage.  I was not too sleepy as long as I took it early enough.

Then I went on Abilify and lost 30 lbs but the side effects were awful.  Twitching and tremor and drooling.

Now I am back on Seroquel IR, taking it late at night.  It is working fine and I manage to fall asleep before the hunger takes over.  

I am on a low dose of 200 mgs.  You really need to try both to find your best option.  It is expensive however. 

I am on the "me too" of Abilify, Rexulti. I actually did notice I have been drooling a bit at night when I sleep since starting Rexulti, but since decreasing my dose to 1mg I haven't been having this problem as much. I think for now the IR seroquel it working, I also take it late at night, when I do. Even with me taking it so late, like 11 or 12, I don't get too much morning hangover effects. I stay awake and love the hunger it gives me but after I eat im pretty much done and drag myself to bed. 200mg is what has been working for me also, but I thought this was kind of a high dose. I guess 200 isn't really that large, considering XR is dosed at 800mg in acute bipolar mania or mixed episodes. Im glad I have room to increase my dosage if I begin to find that its not helping in my acute manic episodes.

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  • 2 years later...

Hi there. I have been on serequel xr 300mg. I was on same dose for 7 years and I started getting side effects like racing heart and breathlessness. I stopped it and got 100 mg IR instead until I meet with the psych. So far I have noticed better sleep on IR. It's only been 2 days and it's better sleep than 7 years I was on XR. In terms of weight etc i still have that to see but 100mg IR has given better sleep.Can you tell me if you use 50mg on daily and then increase if you feel manic episode is coming? Can you do that I'm just wondering. 

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@Mrsal, this thread hasn’t been active for a while. Opening it back up again is fine. I’m not sure if the OP has been around lately, but @aura and @CrazyRedhead and I are still here. 

I couldn’t tell from your question to whom exactly you wanted to speak. Can you clarify your question a bit so we can answer better?

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