800 mg Seroquel to zero in 4 days ( been on it for 9 years min)

[Wonderful.Cheese]

I'm being switched off invega 12 mg and Seroquel XR 800 mg to zyprexa zydis 10 mg. Pdoc is taking me off 800 mg Seroquel XR to 400 mg for four nights then zero Seroquel. I've been on Seroquel for 9 years at the very minimum. What can I expect? I know there is a mania risk but will I be physically ill too?

The invega will remain the same for now (although next week we will remove it as well just as quickly probably). Abilify 35 mg remains (plan to remain on this one along with the zyprexa zydis). While adding the zyprexa zydis 10 mg at bedtime. 

Any thoughts?

Edited February 2, 2018 by Wonderful.Cheese

[mikl_pls]

Here's what Dr. Stephen Stahl has to say about it in his book Stah's Essential Psychopharmacology (4th ed.).

Quote

The art of switching antipsychotics

[...]

Switching between two agents that have similar pharmacology is generally easiest, fastest, and has the fewest complications, namely a pine to a pine, or a done to a done, over as little as a week's time.

 

There are diagrams depicting graphs of how long to cross-titrate antipsychotics (of what time to what type), and from a "pine" to a "pine" (in your case "quetiapine" (Seroquel) to "olanzapine" (Zyprexa Zydis), there would be a one week period minimum of cross-titration (going down off quetiapine and going up on olanzapine), then by the next week, ideally, you would be off of quetiapine and on the full dose of olanzapine.

So you are going from 800 mg quetiapine to 400 mg for four nights? According to this, that's too quickly, but your pdoc must know something we don't. I mean, you are, after all, on three antipsychotics, and you did say you were going to be on the Invega and adding the Zyprexa Zydis, right? So maybe this is a different cross-titration technique?

Do I have this right?

• Day 1: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 2: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 3: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 4: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 5 and on: Abilify 35 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• At some point in the future: Abilify 35 mg, Zyprexa Zydis 10 mg, Invega (reduced dose?)
• At some point in the future: Abilify 35 mg, Zyprexa Zydis 10 mg (Target)

Ideally, if switching from a -pine to a -pine, such as quetiapine to olanzapine, you shouldn't have too much of a problem due to their similar pharmacology as Stahl stated, but if you have more Seroquel XR 400 mg to go for just four nights, perhaps, with your pdoc's discretion, you could keep with the Seroquel XR 400 mg a few days longer and then try to discontinue it with the Zyprexa Zydis on board, or if you still can't kick it, maybe you could call her up and ask for a smaller dose between, say, 150-300 mg, to help the titration be more gradual?

Did she say how the Invega would be discontinued? Would it be titrated or quit cold turkey? (Surely not the latter...)

[saintalto]

I went off seroquel, at around the same dose, after having been on it for over 15 years and it was rough at first. They tapered me off much slower than 4 days though. If I recall it was much longer than a week even. I was put in IOP while the switch was being made because I was doing pretty poorly. Got really delusional (not that IOP really helps with psychosis but it meant I wasn’t alone all day). 

I should add that during this time I was also taken off risperdone at the same time and I had to pretty much completely go off both seroquel and risperdone before I started the new drug. They were cutting back my antipsychotics down to one as well. 

Edited February 3, 2018 by saintalto

[Wonderful.Cheese]

13 hours ago, mikl_pls said:

Here's what Dr. Stephen Stahl has to say about it in his book Stah's Essential Psychopharmacology (4th ed.).

There are diagrams depicting graphs of how long to cross-titrate antipsychotics (of what time to what type), and from a "pine" to a "pine" (in your case "quetiapine" (Seroquel) to "olanzapine" (Zyprexa Zydis), there would be a one week period minimum of cross-titration (going down off quetiapine and going up on olanzapine), then by the next week, ideally, you would be off of quetiapine and on the full dose of olanzapine.

So you are going from 800 mg quetiapine to 400 mg for four nights? According to this, that's too quickly, but your pdoc must know something we don't. I mean, you are, after all, on three antipsychotics, and you did say you were going to be on the Invega and adding the Zyprexa Zydis, right? So maybe this is a different cross-titration technique?

Do I have this right?

• Day 1: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 2: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 3: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 4: Abilify 35 mg, Seroquel XR 400 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• Day 5 and on: Abilify 35 mg, Zyprexa Zydis 10 mg, Invega 12 mg
• At some point in the future: Abilify 35 mg, Zyprexa Zydis 10 mg, Invega (reduced dose?)
• At some point in the future: Abilify 35 mg, Zyprexa Zydis 10 mg (Target)

Ideally, if switching from a -pine to a -pine, such as quetiapine to olanzapine, you shouldn't have too much of a problem due to their similar pharmacology as Stahl stated, but if you have more Seroquel XR 400 mg to go for just four nights, perhaps, with your pdoc's discretion, you could keep with the Seroquel XR 400 mg a few days longer and then try to discontinue it with the Zyprexa Zydis on board, or if you still can't kick it, maybe you could call her up and ask for a smaller dose between, say, 150-300 mg, to help the titration be more gradual?

Did she say how the Invega would be discontinued? Would it be titrated or quit cold turkey? (Surely not the latter...)

Yes you do indeed have the plan for getting off Seroquel xr correct. That is what she said and what my med box was changed to. So far so good but it's only been one night. Thanks for that info!!! If I do have problems I will let her know and ask for a longer period of time to get off the Seroquel xr. I did suspect that it seemed kind of quick. Oddly I feel less sedated thus far but it has only been one day like I said. 

I see her in a week because of the high mania risk with my history of going off Seroquel and then boom mania. So if things are going well then next Friday she will figure out how to get me off invega. I have 9 mg pills and 3 mg pills of invega. So hopefully not cold turkey. If she says that I will ask for a titration using the pills I have. 9 mg then down to 3 mg then none would make sense? But cold turkey seems cruel?

And I keep forgetting to answer your question! I apologize! I take 30 mg abilify at bedtime and 5 mg abilify in the morning. Lol sorry random remembering. 

13 hours ago, saintalto said:

I went off seroquel, at around the same dose, after having been on it for over 15 years and it was rough at first. They tapered me off much slower than 4 days though. If I recall it was much longer than a week even. I was put in IOP while the switch was being made because I was doing pretty poorly. Got really delusional (not that IOP really helps with psychosis but it meant I wasn’t alone all day). 

I should add that during this time I was also taken off risperdone at the same time and I had to pretty much completely go off both seroquel and risperdone before I started the new drug. They were cutting back my antipsychotics down to one as well. 

I'm sorry you had such a rough time with going off Seroquel and risperdal! Yikes! I agree about the IOP experience. But what can you do I guess if it's needed. Darn. 

Thanks for the info. I appreciate it. So far so good for me with the reduced dose but we will have to see. I hope it goes well. 

[mikl_pls]

2 hours ago, Wonderful.Cheese said:

I see her in a week because of the high mania risk with my history of going off Seroquel and then boom mania. So if things are going well then next Friday she will figure out how to get me off invega. I have 9 mg pills and 3 mg pills of invega. So hopefully not cold turkey. If she says that I will ask for a titration using the pills I have. 9 mg then down to 3 mg then none would make sense? But cold turkey seems cruel?

I hope things go well with going off Seroquel XR so you can go on to get off Invega.

Yeah, 12 mg to 9 mg to 3 mg makes sense. I would think having 6 mg in there in between the 9 mg and 3 mg would be nice (if you can break the 12 mg in half? But I know they're ER...). But it definitely makes more sense than going off of it cold-turkey! Stahl says switching from a -done to a -done (paliperidone for Invega) can be done in one week, but you're not switching, you're discontinuing, so I dunno how long she'll want you to take to go off Invega. I would guess a week minimum though to go off of it. But in my opinion, the slower and more gradual, the better. But I'm no expert!

2 hours ago, Wonderful.Cheese said:

And I keep forgetting to answer your question! I apologize! I take 30 mg abilify at bedtime and 5 mg abilify in the morning. Lol sorry random remembering.

Hey, no worries! lol I was just curious is all. It seems excessive to take that much Abilify, and expensive too.

[crtclms]

Cheese, I am not saying I know what I'm doing, but Abilify sent me through the roof. It probably works well for you, but if you end up looking for a culprit for mania, you might want to keep it in mind.

[Wonderful.Cheese]

2 hours ago, mikl_pls said:

Hey, no worries! lol I was just curious is all. It seems excessive to take that much Abilify, and expensive too.

Yes. It is excessive, I totally agree. I'm fighting my battles as I can because I do have a lot to prove given my history of crazee and hospitalizations etc. Pdoc is already leary that I'm going from 3 AAP'S down to 2. And especially a "low" dose of one ("only" 10 mg of zyprexa zydis). She was ready to put me on 40 mg zyprexa then 20 mg when I told her that was my past dose. It is kinda expensive but husband works for the government so we do have decent insurance coverage mail order so I can't complain too much. But yes, I want to get it down to 30 mg. I will work on that with her after I can prove myself doing ok on 2 AAP'S with one at a moderate dose. Here's hoping!

[Wonderful.Cheese]

1 hour ago, crtclms said:

Cheese, I am not saying I know what I'm doing, but Abilify sent me through the roof. It probably works well for you, but if you end up looking for a culprit for mania, you might want to keep it in mind.

Interesting. I never considered Abilify could be a culprit. I've been on it so long, like over 10 years now. Back when it cost a million dollars and was brand name. But it is interesting because I've almost always needed a second AP with Abilify. I was on it as my only AAP briefly enough to get me out of a long state hospital stay but I wasn't stable for long because I ended up back there not terribly long afterwards. Then they put me on other AAP'S with Abilify. Finally settling on zyprexa pills then Seroquel IR later on. I've been on Abilify so long I don't know what it does for me anymore. But I'm terrified to get off of it and possibly deteriorate.  

[browri]

@Wonderful.Cheese yeah aripiprazole is paradoxical for some people. It can help some manic symptoms but it can make agitation and impulsivity worse. Doesn't work completely for everyone. But if you think you're agitated overall and you want to make a change, lowering or replacing aripiprazole would be a good start with your doctor's supervision.

Considering though that you've been on quetiapine, olanzapine, and aripiprazole; those help a lot with negative depressive symptoms, and while Abilify might not be the best for your mania, it may be holding together your depressed mood if that is a problem for you.