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- Dec 29, 2012
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Just received a patient from a doctor who retired. Female, 29, nonsmoker. For at least 10 years has had a diagnosis of OCD and Tic Disorder NOS. Patient came to me on 30 mg Paxil and 50 mg Seroquel.
The patient wants off the Seroquel. She has been taking it nightly at 50 mg for at least 10 years, and very dutifully (as in never having missed a day). She says that she never liked the way it made her feel and that it was never prescribed for sleep. It was prescribed originally as a daytime med for OCD and tics. Her doctor moved the dosing to night because she couldn't stay awake on it.
The patient now complains that after she takes it, her heart races and pounds, and she is breathless. Patient already has a diagnosis of idiopathic tachycardia and POTS, for which her treatment is exercise and hydration. She has resisted beta-blockers.
She wants to come off Seroquel, and I would like her too, as well. I checked her A1C and it was 6.4. She is overweight (BMI of 29.9). I was under the impression that Seroquel at a dose like this only acted on histamine receptors.
Is there any reason I couldn't take her off cold turkey? Or should his be tapered? Her smallest pills are 25 mg, but she says she can split them. I'm not quite sure what this dosage has been doing for her if anything except cause sleepiness. Because I can't find any information on long-term, low dosage use, I also don't know what we should expect in terms of how withdrawing the drug will affect her.
Any suggestions on handling this? She doesn't seem to be concerned about insomnia, so I guess I am OK there.
The patient wants off the Seroquel. She has been taking it nightly at 50 mg for at least 10 years, and very dutifully (as in never having missed a day). She says that she never liked the way it made her feel and that it was never prescribed for sleep. It was prescribed originally as a daytime med for OCD and tics. Her doctor moved the dosing to night because she couldn't stay awake on it.
The patient now complains that after she takes it, her heart races and pounds, and she is breathless. Patient already has a diagnosis of idiopathic tachycardia and POTS, for which her treatment is exercise and hydration. She has resisted beta-blockers.
She wants to come off Seroquel, and I would like her too, as well. I checked her A1C and it was 6.4. She is overweight (BMI of 29.9). I was under the impression that Seroquel at a dose like this only acted on histamine receptors.
Is there any reason I couldn't take her off cold turkey? Or should his be tapered? Her smallest pills are 25 mg, but she says she can split them. I'm not quite sure what this dosage has been doing for her if anything except cause sleepiness. Because I can't find any information on long-term, low dosage use, I also don't know what we should expect in terms of how withdrawing the drug will affect her.
Any suggestions on handling this? She doesn't seem to be concerned about insomnia, so I guess I am OK there.