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I started Seroquel at 100mg, 50 am and 50pm. Was increased to 150mg, 50mg 3x a day. This was RXd for Bipolar 2 hypomania.

Every time I take it I get horrible nasal congestion. I got the same thing on Risperdal.

I know this is due to the medicine hitting an adrenergic receptor. My question is, are there ANY atypicals that don't touch these receptors? Or don't hit them so hard?

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I was looking on Wikipedia and it looks like Zyprexa might not hit the adrenergic receptors as had as Seroquel or Risperdal. Any suggestions?

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Talked with my pdoc and he suggested that this side effect with lessen over time. We also increased to 150XR in the AM and 100 IR at night.

Has anyone experienced a lessening of side effects from Seroquel over time? Did the XR formulation have less side effects?

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52 minutes ago, bpjett said:

Talked with my pdoc and he suggested that this side effect with lessen over time. We also increased to 150XR in the AM and 100 IR at night.

Has anyone experienced a lessening of side effects from Seroquel over time? Did the XR formulation have less side effects?

Really sorry no one has replied...  I’m not sure, so I’ll summon the medication gods. 

@mikl_pls @Iceberg @notloki. @argh?

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I can't speak for my own experience with Seroquel because I've never taken the XR formulation, and the highest dose I've taken is 100 mg of the IR version. I have not really had much nasal congestion (more than normal anyway...) with both trazodone and Seroquel, both of which antagonize the α1-adrenergic receptors pretty potently. This causes a vasodilating effect which may be responsible for the nasal congestion you're experiencing. Risperidone also hits the α1 receptors pretty hard, actually more so than Seroquel.

Olanzapine (Zyprexa) doesn't hit the α1 receptors nearly as hard, but it's a very bad drug in with regards to causing enormous weight gain and type 2 diabetes. There are probably other meds available that can help without antagonizing the α1 receptors, such as Vraylar or Latuda.

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10 minutes ago, mikl_pls said:

I can't speak for my own experience with Seroquel because I've never taken the XR formulation, and the highest dose I've taken is 100 mg of the IR version. I have not really had much nasal congestion (more than normal anyway...) with both trazodone and Seroquel, both of which antagonize the α1-adrenergic receptors pretty potently. This causes a vasodilating effect which may be responsible for the nasal congestion you're experiencing. Risperidone also hits the α1 receptors pretty hard, actually more so than Seroquel.

Olanzapine (Zyprexa) doesn't hit the α1 receptors nearly as hard, but it's a very bad drug in with regards to causing enormous weight gain and type 2 diabetes. There are probably other meds available that can help without antagonizing the α1 receptors, such as Vraylar or Latuda.

Thank you for your reply. Looks like Vraylar antagonizes the a1 receptor the least. 

Anyone have experience with this med? I'm becoming semi dependent on oxymetazoline nasal spray, which I know will make things worse with rebound congestion, but I cannot sleep with my nose blocked. 

Anyone have any suggestions for non-nasal spray solutions for the rhinitis?

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31 minutes ago, bpjett said:

Thank you for your reply. Looks like Vraylar antagonizes the a1 receptor the least. 

Anyone have experience with this med? I'm becoming semi dependent on oxymetazoline nasal spray, which I know will make things worse with rebound congestion, but I cannot sleep with my nose blocked. 

Anyone have any suggestions for non-nasal spray solutions for the rhinitis?

I take Vraylar and don't have any issues with nasal congestion. I also took Latuda and didn't have any problems with nasal congestion with it either.

Levocetirizine (Clarinex) is supposed to be good for nasal congestion (it's an antihistamine that is the successor of Claritin).

They make adhesive nasal strips that work pretty well for me when I have nasal congestion at night. Here are the ones I use. https://www.breatheright.com/ You can usually get them at any drug store or places like Walmart or Target.

 

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😕 First thing I tried was the BreatheRight strips. No good. I'll check out Clarinex. Is that OTC or Rx?

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Just now, bpjett said:

😕 First thing I tried was the BreatheRight strips. No good. I'll check out Clarinex. Is that OTC or Rx?

Aaah, I see. That's unfortunate. Clarinex is prescription only. There's another med called Xyzal that they recently made OTC that used to be prescription only. It's the successor to Zyrtec. I took it for a while too and it seemed to help moderately with nasal congestion.

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4 hours ago, bpjett said:

Talked with my pdoc and he suggested that this side effect with lessen over time. We also increased to 150XR in the AM and 100 IR at night.

Has anyone experienced a lessening of side effects from Seroquel over time? Did the XR formulation have less side effects?

Not sure about that one symptom specifically, but it is not uncommon for people to “acclimate” a bit after being on a constant dose for awhile and feel less side effects. This is common with sedation for AAPs, once you get to a set dose for awhile many people report that they either feel less sedated or can manage the sedation better. Unfortunately, I don’t know if that will carry over to congestion. 

I’d be careful what you wish for with zyprexa, it can bring a whole host of other issues 

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Posted (edited)

I've never been on seroquel or any AP/AAP personally so I can't quite say.

I know remeron, an AD which hits the a1/2/3 decently hard did give me a stuffy nose. Which is ironic as hell as it was the most potent anti-histamine ever. like when that side effect went away, i could probably snort a line of dust without sneezing for the next few hours.

It might be that effect going on.

Edited by argh
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4 hours ago, bpjett said:

Thank you for your reply. Looks like Vraylar antagonizes the a1 receptor the least. 

Anyone have experience with this med? I'm becoming semi dependent on oxymetazoline nasal spray, which I know will make things worse with rebound congestion, but I cannot sleep with my nose blocked. 

Anyone have any suggestions for non-nasal spray solutions for the rhinitis?

Is seroquel working? Seroquel to Vraylar could be a big jump as far as mechanism and effects, so if seroquel is currently working that might be a risky switch 

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It is... Sort of. I'm still having manic symptoms, excessive spending, racing thoughts, random sleeping patterns, obsessive cleaning/organizing, agitation, but that's why we increased to 250mg total. 150mg XR in the AM, 100mg IR before bed.  I haven't started on that dose yet. My pharmacy didn't have the 150mg XR in stock.

What's the difference in binding profile in Vraylar vs Seroquel?

17 hours ago, argh said:

Like when that side effect went away, i could probably snort a line of dust without sneezing for the next few hours.

🤣🤣🤣

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1 hour ago, bpjett said:

It is... Sort of. I'm still having manic symptoms, excessive spending, racing thoughts, random sleeping patterns, obsessive cleaning/organizing, agitation, but that's why we increased to 250mg total. 150mg XR in the AM, 100mg IR before bed.  I haven't started on that dose yet. My pharmacy didn't have the 150mg XR in stock.

What's the difference in binding profile in Vraylar vs Seroquel?

🤣🤣🤣

Yeah you’ve got a ways to go before calling it on seroquel. Some people (me included) hit 800+. 

The major difference is Vraylar works as a partial agonist at D3 while seroquel is an antagonist at D2.  Both are 5HT2A antagonist (like many other aaps, but Vraylar has less affinity, making it somewhat unique according to Stahl) and a 5HT1A partial agonist which help to address depression..  seroquel also hits H1 which can account for sedation/sluggishness etc. while Vraylar acts on Alpha 1B which supposedly mitigates EPS

 

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1 hour ago, Juniper29 said:

I had congestion and breathing trouble on seroquel. I had to stop because of it.

Were you able to find a suitable replacement? 

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38 minutes ago, bpjett said:

Were you able to find a suitable replacement? 

Abilify ... but I'm not sure if it would help hypomania since it's more activating. I take it for psychotic depression.

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I'm going to give it a few more weeks with the Seroquel. I do feel a slight improvement, but this sinus blockage is making me miserable. I'm going to try to stop using the Afrin and try Zyrtec and Flonase. 🤞

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On 8/16/2019 at 2:54 PM, bpjett said:

Talked with my pdoc and he suggested that this side effect with lessen over time. We also increased to 150XR in the AM and 100 IR at night.

Has anyone experienced a lessening of side effects from Seroquel over time? Did the XR formulation have less side effects?

Theoretically the XR may have less weight gain than the IR formulation but I can't speak to the other side effects.

However, that IR dose in the evening may be part of your problem and it may be worth going to 250-300mg of the XR in the morning because at that dose Seroquel should start to become more stimulating via norepinephrine activation (usually begins after 200mg). My thinking is that you have this 150mg that's distributed throughout the day and then a booster of 100mg at night which could be exacerbating the nasal congestion. It may be better to do more of the XR in the morning and less of the IR in the evening.

On 8/20/2019 at 7:26 PM, bpjett said:

I'm going to give it a few more weeks with the Seroquel. I do feel a slight improvement, but this sinus blockage is making me miserable. I'm going to try to stop using the Afrin and try Zyrtec and Flonase. 🤞

More than likely any of the anti-histamines will just dry you out as Seroquel itself is an anti-histamine, so I personally wouldn't recommend Zyrtec (cetirizine), Xyzal (levocetirizine), Claritin (loratadine), Clarinex (desloratadine), Allegra (fexofenadine). However, I would recommend Flonase, particularly the Sensimist which is fluticasone furoate instead of fluticasone propionate. Less spray volume so less post-nasal drip and it doesn't have a terrible taste or floral smell the way the regular Flonase does. Fluticasone is a steroid and should reduce inflammation. Whether it will reduce inflammation caused by vasodilation via alpha 1 adrenergic antagonism idk, but I'm inclined to think it'll work better than anti-histamines would.

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24 minutes ago, browri said:

Theoretically the XR may have less weight gain than the IR formulation but I can't speak to the other side effects.

However, that IR dose in the evening may be part of your problem and it may be worth going to 250-300mg of the XR in the morning because at that dose Seroquel should start to become more stimulating via norepinephrine activation (usually begins after 200mg). My thinking is that you have this 150mg that's distributed throughout the day and then a booster of 100mg at night which could be exacerbating the nasal congestion. It may be better to do more of the XR in the morning and less of the IR in the evening.

More than likely any of the anti-histamines will just dry you out as Seroquel itself is an anti-histamine, so I personally wouldn't recommend Zyrtec (cetirizine), Xyzal (levocetirizine), Claritin (loratadine), Clarinex (desloratadine), Allegra (fexofenadine). However, I would recommend Flonase, particularly the Sensimist which is fluticasone furoate instead of fluticasone propionate. Less spray volume so less post-nasal drip and it doesn't have a terrible taste or floral smell the way the regular Flonase does. Fluticasone is a steroid and should reduce inflammation. Whether it will reduce inflammation caused by vasodilation via alpha 1 adrenergic antagonism idk, but I'm inclined to think it'll work better than anti-histamines would.

It's definitely worth a try. The nasal congestion is starting to affect my relationship with my partner now. He can barely stand the fig horn snoring that comes with the congestion and often ends up sleeping on the couch. 😕

Hopefully this will let up sooner than later. I'm picking up the XR today and will take it for the first time tomorrow morning. I'm going to pick up some Flonase while I'm there.

Wish me luck! I just want to be able to breathe! 

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