Does the XR Version of Seroquel Minimize Side Effects?
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Q:  Does the XR Version of  Seroquel Minimize Side Effects?

I have been diagnosed with Bipolar II, with comorbid panic disorder and generalized anxiety. My doctor has suggested Seroquel XR to help with the anxiety. I'm a little concerned about side effects. Would an extended release version of Seroquel minimize side effects?   

Thanks for your help.                    

Dear Mr. M. --

Although not yet published, the manufacturers of Seroquel XR have recently presented data supporting the use of the XR approach for the treatment of generalized anxiety. Quite low doses were effective. 

What we don't have, is a comparison study of the XR versus the older immediate release version of Seroquel.  That might allow us to more specifically address your question about which one has fewer side effects. 

So far, my experience using the XR version is very limited.  The doses of XR used in the anxiety studies are not yet available; they are much lower than the currently available 300 mg XR, or the just -arriving 200 mg XR.  I like to start with a much lower dose of Seroquel, 25-50 mg.  So I have been hesitant to use the much larger doses that one is stuck with using the XR approach.  Therefore, I do not have much experience on which to base a comparison between the two approaches, as regards side effects.  

Your doctor may have much more experience with it.  The whole idea of the XR was to minimize the substantial nighttime sedation which often extends into the following morning.  I have had some success swapping to the XR in patients who are taking very high doses -- but have not done this using the low doses which are sometimes effective in bipolar II. 

Perhaps the most important point is to emphasize that even using the immediate release version of Seroquel, in most patients it is possible to work around the sedation which is common with this medication.  In close communication with your physician, you may be able to adjust the dose downward if daytime sedation is a problem.  Because of this side effect decreases as one gets used to the medication (within four to seven days, generally), sedation is usually only a temporary problem. 

There are other side effects from Seroquel, such as a potential for weight gain and increasing glucose levels, which are much more concerning.  So far we do not have evidence that these are less of a problem with the XR version. There are some data indicating that these issues are potentially "dose-related", meaning that the problem becomes greater as the dose goes up.   

Similarly, a long-term risk of Seroquel and other similar medications is "tardive dyskinesia". This is a movement disorder that you should understand if you get a good response to Seroquel and are planning to stay on it.  This risk is also dose -related. Obviously this would suggest that the lowest effective dose is best.  When we get some smaller sizes of the XR, it will be easier to establish that lowest effective dose. 

Dr. Phelps

Published July, 2008


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