Q:  Seroquel & Orthostatic Hypotension

dx of bpi/ii for 10 yrs.  current med regimen: 900 lico3, lamictal 200 mg, seroquel 400 mg x 1.5 yrs.

during this past 1.5 yrs, pretty darn stable on this list of meds with very few side effects, very very med compliant.  past few mos waking up at night heart pounding, happening 2-3 x's per mo.  able to return to sleep eventually.  if prob returning to sleep take .5 klonopin. 

last night woke up w heart pounding, got up to go to bathroom and nearly freaking fainted-first time in my life-had to crawl back to bed-light headed, very tipsy-very out of the ordinary. if i didn't pass out in bed, i was really absnormally crashed out. aware that seroquel is SE labeled for orthostatic hypotension, however primarily during initial taper which is certainly not the case.

i would consider panic attack, if were not for pretty darn near syncope.  no family hx of heart conditions.  as far as i can tell, no change in recent diet, sleep, meds, dehydration etc.etc.etc.

have done google searches for noctural postural/orthostatic hypotension with no really helpful results.  seroquel and orthostatic/postural hypotension yields hits of seroquel SE disclosure.

at this pt pounding liquids trying to combat possible volume deficiency...?

thoughts?

btw, please erase email address if you are to post on your site, as confidentiality is important to me.

thanks,
 

Dear E' --
Hmm, better tell your doc', who might consider an electrocardiogram and some other basic tests.  Got to make sure you're not having rhythm problems associated with this apparent low blood pressure to the squash (aka brain). Or blood chemistry abnormalities possibly associated with lithium, so need to check kidneys, basic chemistry panel, and might as well check thyroid while you're at it.  Rarely lithium can cause calcium abnormalities through the parathyroid glands (this will show up on the chemistry panel). None of this sounds straightforward (why now? why lying down?), so you need to start will "all the usual suspects" for near syncope and go from there. You're right to check Seroquel but this doesn't sound like the orthostatic hypotension associated with that medication, as you've figured out. 

Dr. Phelps



Published August, 2005