Any one ever maxed out Seroquel XR here?

Discussion in 'General Parenting' started by gcvmom, Aug 24, 2008.

  1. gcvmom

    gcvmom Here we go again!

    I've read that the maximum dosage for Seroquel XR is 800mg.

    Has anyone here reached that level... or gone beyond it for BiPolar (BP)?

    difficult child 2 is at 600mg for the past week now. He's still hitting spots during the day where he is REALLY fidgety and impulsive... usually around late afternoon, early evening which stays until he gets his evening dose. About an hour and a half after that, he's usually asleep.

    Mornings are pretty good. I just don't know how he's going to get through the entire school day, though.

    And I don't know if maxing out the Seroquel is the right idea or adding a short-acting dose in the afternoon would be better. Or is this just not even the right medication?

    Since stopping the Depakote, he thinks SO much more clearly. I don't think I want to take him back to that!

    And he can't tolerate any of the other AP's since he developed dystonic reactions to each of them this past year (Zyprexa, Abilify, Risperdal).

    I'll be calling the psychiatrist with my update tomorrow, but thought I'd toss this one out there.
  2. totoro

    totoro Mom? What's a GFG?

    K is not on the ER and she only takes 125mg split into 3 times a day.
    I have read that 800 mg is the max also. Here is what the medication guru says...

    Sorry it wont let me link it directly to the dosage about Seroquel or the Seroquel fact sheet?
    But you can just scroll down and check it out if you want. He says 300-600mg have been typically what works best from what he has read and seen.
    If K doesn't do well at this dose we may increase a bit, but our next route will be to add Lithium. Depakote did not work for us either.
  3. gcvmom

    gcvmom Here we go again!

    So is she taking a total of 125mg, or 375mg?
  4. smallworld

    smallworld Moderator

    My son went up to 800 mg regular Seroquel while in day treatment last winter. He was staying up all night for several weeks, and we needed to get his mania under control. It worked, and as an added benefit, his depression lifted for the first time in more than two years. But when he got out of day treatment, his outside psychiatrist was not comfortable with J taking such a high dose so the psychiatrist lowered it over time. We went down to 400 mg, and J's depressive symptoms started to reappear. So J is currently taking 600 mg regular Seroquel with good results.

    J did not have good success with Seroquel XR. It seemed as if he were more sleepy and overmedicated. J takes his Seroquel dose all at night, but I've read of other kids who split Seroquel in three to four doses over the course of the day. You may want to try that -- 200 mg in the morning, after school and evening -- to see if your difficult child's symptoms are more under control. I think it's worth a shot before having to go up more, although I've certainly heard of other kids taking 800 mg Seroquel.

    What about Lamictal as an add-on? Didn't your difficult child do well on it before?
  5. gcvmom

    gcvmom Here we go again!

    SW, he was on it briefly, but his impulse control was not that great. Plus, he was on a stimulant at the time, so that was probably making things worse. psychiatrist feels that difficult child 2's problems are not so much on the depressive end (although, he was picking at himself and becoming very emotional when we added Lamictal last winter. That's when he was still on a stimulant and Depakote).

    Thing is, he's taking the XR. So I don't know if it's advisable to spread that dosing out like you normally would with a short acting drug.

    The positive with him being at 600 now is that the food binging is gone and the grogginess is improving somewhat (although he's still sleeping 10-12+ hours... maybe that's o.k. for an 11yo?)

    We just need to figure how to curb these periods of hyperactivity and impulsiveness which I guess you could classify as hypomania. He's better, but not enough. We were at a comedy show to watch his cousin on Saturday, and difficult child 2 was literally rocking in his seat, grabbing the cusion between his legs and pulling on it and rocking (laughing, too, albeit a bit TOO loudly, because of the show). The seats were old and squeaky, so it was very disruptive, otherwise I'd say so what.

    Last night at dinner in a restaurant, he was trying to pour a "drop" of water on his plate which, because of his fine motore problems nearly resulted in the entire glass being dumped if it weren't for quick intervention. He had soaked his placemat and was in the process of tearing it up. He kept reaching for things in front of others and nearly knocking other things over. But he DID remain in his seat. His volume control was pretty good. And he wasn't being provocative -- just impulsive and fidgety, doing the kinds of things you'd expect a 2yo to do. Also, when he gets like this, others have noticed (and us as well) that his eye contact is not great. When medications are working, though, he's very aware and connected.

    Okay, so I guess I'll call the psychiatrist.

    I don't want to go back to Depakote because of the cognitive dulling it gave him.
  6. smallworld

    smallworld Moderator

    I meant switching to regular Seroquel (NOT XR) and spreading it out in three doses over the day. I've known several kids, not just my son, who didn't do all that well on Seroquel XR.
  7. gcvmom

    gcvmom Here we go again!

    Maybe that's what we need to do. I'll ask.

  8. totoro

    totoro Mom? What's a GFG?

    Yes K takes a total of 125mg, 50 mg in the am, 25 mid-day and 50 mg at night. She does not take the ER either. We have not tried the ER.
  9. timer lady

    timer lady Queen of Hearts

    kt maxed out on seroquel when she was 9 or 10 years old (really cannot remember right now with-o her records in front of me).

    For 2 years or so, psychiatrist added a prn of zyprexa into kt's regime, while he slowly tapered her down. She's currently at 400 mg/daily & doing well.

    by the way, kt's sleepiness went away after a bit; her weight gain was notorious however she's slimmed out over the last year & is looking good.
  10. gcvmom

    gcvmom Here we go again!

    Thanks, Toto. That seems low to me, but then every person is different. difficult child 2 has historically needed higher doses of medications for them to work (his dad's the same way).

    TL, It sounds like we'd be okay if he did go to 800mg. Our psychiatrist generally doses medications based on response rather than any hard and fast rule. I imagine he'll call back today or tomorrow.

    difficult child 2's weight gain was very noticeable at first. But in the last three weeks or so, his "binge" eating has stopped and he's actually refusing food when he's not hungry (before he'd eat anything, any time). Someone commented this weekend that he looks like he's dropped some weight, much to my relief! I think he had gained about 15 pounds since June.
  11. jjkklw

    jjkklw New Member

    I have just been upped to 900 mg daily taken once at night...
  12. TerryJ2

    TerryJ2 Well-Known Member

    Just sending hugs ...
  13. tiredmommy

    tiredmommy Site Moderator

    This is an old thread.
  14. TerryJ2

    TerryJ2 Well-Known Member

    Holy cow! lol! I saw the month but not the yr.
    Well, maybe a newcomer will find it useful. :)
  15. tiredmommy

    tiredmommy Site Moderator

  16. kamissick

    kamissick New Member

    I did take 800mg when I was "bipolar". My psychiatrist was stubborn on the fact that I was bipolar, and was CONVINCED I was psychotic. I took 800mg of Seroquel XR, that was the worst peak of my life. I was literally psychotic BECAUSE of the medicine. I cut all the medicine, switched psychiatrist, and my diagnosis was completely changed!