Quetiapine XR vs IR

[Merovinge]

Curious people's experience w/ Seroquel XR vs IR. I have only seen IR used, with the rationale that the medication can still be used once daily QHS due to the active metabolite and possibly just a regional experience. I recently inherited a patient that was switched to XR at the same dosage (200mg) and has seen an increase in day-time somnolence. Clearly peak somnolence is increased with IR dosing, patient's family was told that XR would better control symptoms throughout the day. I have tried to find data on this and it seems to be quite lacking in the literature.

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[ObsequiousAplomb]

Curious people's experience w/ Seroquel XR vs IR. I have only seen IR used, with the rationale that the medication can still be used once daily QHS due to the active metabolite and possibly just a regional experience. I recently inherited a patient that was switched to XR at the same dosage (200mg) and has seen an increase in day-time somnolence. Clearly peak somnolence is increased with IR dosing, patient's family was told that XR would better control symptoms throughout the day. I have tried to find data on this and it seems to be quite lacking in the literature.

I frequently receive patients with similar stories to what you're describing, where the previous provider said better daytime coverage with XR. Especially when used as an adjunct for GAD. If they have daytime fatigue I either switch to IR or try a different med. It hasn't backfired on me yet, but I admit this isn't based on any evidence or studies.

 

[deleted1100659]

I have tried some people on XR and there didnt seem to be a significant difference. I personally just use IR if I dose it. If somnolence I dose it at night anyways, generally people seem to like the sleep effect here, lol. I think the main reason people does it BID or TID probably is sedation effection helps calm people down whether its for anxiety component, aggression, etc. I do tend to do BID dosing with the IR though, but if daytime sedation is an issue I will consolidate the dose to nighttime and just ensure no orthostatic hypotension.

 

[mistafab]

There is a “toll the bell” hypothesis for antipsychotics that seems to hold true (when used for psychotic disorders). The dopamine receptor just needs to get hit regularly, and doesnt seem to matter if it gets hit once a day or multiple times a day.

Effectiveness of different dosing regimens of risperidone and olanzapine in schizophrenia - PubMed

The objective of this study was to evaluate the effectiveness and impact of once- versus twice-daily dosing of risperidone and olanzapine on clinical outcomes in patients with schizophrenia. Data from phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)...

pubmed.ncbi.nlm.nih.gov

the study above looked particularly at risperidone and olanzapine, but you can somewhat generalize this. No difference in daily vs bid dosing.

As an aside, Id ask why the TDD of quetiapine being used is so low anyway. Is it a kid? Anti dopamine isnt really happening until 400mg or more.

 

[Merovinge]

There is a “toll the bell” hypothesis for antipsychotics that seems to hold true (when used for psychotic disorders). The dopamine receptor just needs to get hit regularly, and doesnt seem to matter if it gets hit once a day or multiple times a day.

Effectiveness of different dosing regimens of risperidone and olanzapine in schizophrenia - PubMed

The objective of this study was to evaluate the effectiveness and impact of once- versus twice-daily dosing of risperidone and olanzapine on clinical outcomes in patients with schizophrenia. Data from phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)...

pubmed.ncbi.nlm.nih.gov

the study above looked particularly at risperidone and olanzapine, but you can somewhat generalize this. No difference in daily vs bid dosing.

As an aside, Id ask why the TDD of quetiapine being used is so low anyway. Is it a kid? Anti dopamine isnt really happening until 400mg or more.

Bipolar disorder in a teenager, usually end up around 200-400mg.

 

[Sikrouf]

There is a “toll the bell” hypothesis for antipsychotics that seems to hold true (when used for psychotic disorders). The dopamine receptor just needs to get hit regularly, and doesnt seem to matter if it gets hit once a day or multiple times a day.

Effectiveness of different dosing regimens of risperidone and olanzapine in schizophrenia - PubMed

The objective of this study was to evaluate the effectiveness and impact of once- versus twice-daily dosing of risperidone and olanzapine on clinical outcomes in patients with schizophrenia. Data from phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)...

pubmed.ncbi.nlm.nih.gov

the study above looked particularly at risperidone and olanzapine, but you can somewhat generalize this. No difference in daily vs bid dosing.

As an aside, Id ask why the TDD of quetiapine being used is so low anyway. Is it a kid? Anti dopamine isnt really happening until 400mg or more.

Theres a lot more to quetiapine than dopamine blockade as the doses needed to block the usual 60-80% of d2r are around 1400mg/d ; same story with clozapine

 

[mistafab]

Theres a lot more to quetiapine than dopamine blockade as the doses needed to block the usual 60-80% of d2r are around 1400mg/d ; same story with clozapine

Yes. At lower doses of queriapine it is more like benadryl in its receptor activity.

 

[mistafab]

Bipolar disorder in a teenager, usually end up around 200-400mg.

That makes sense.

 

[NickNaylor]

I pretty much never use the XR formulation due to cost considerations. The few clinical circumstances where I'll specifically opt for the XR formulation is if people have significant issues with side effects in the evenings after dosing (e.g., significant orthostasis, significant sedation, etc.).

 

[Merovinge]

N of 1, but my patient had a "night and day difference" with daytime fatigue resolving when returned to Seroquel IR by myself.