Q:  Seroquel Dosing : Seroquel XL

Two questions for you regarding Seroquel. One your PAR slide (psycheducation.org) your dosing suggests that the Seroquel "starter pack" (50/100/200/300) is for inpatient treatment, whereas you suggest titrating by 25mg for outpatient. Do you still prescribe like this? It is my understanding that the rapid titration is used commonly for outpatient. Second question: What are your thoughts on Seroquel XL for BPD? It seems to be the same dosing as the immediate release, the only difference is the timing of the dose (and the FDA indication).

Thanks for your help.
Terri

 

Hi Terri -
I almost always use a “tip-toe” approach for outpatients (start at 25, sometimes even 12.5 if the person is nervous about sedation, and increase by those increments as fast as possible, sort of titrating to 8 hours of sleep, targeting 300 mg unless she/he starts getting much better sooner, in which case they are to keep that dose), rather than anything even close to the 100/200/300 inpatient approach with the old CR version. As for the XR, I haven’t used it much (why bother? the old one is known and helps with sleep, and most of the time with the new one it’s too sedating during the day for my patients, though I have a few on it who had to switch to use samples and coupons (wasn’t that crafty of the company?)

Jim P.

 
Published June, 2009