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Is It Safe To Double The Dosage Of Depression And Anxiety Medication?
Question: I am currently taking 30mg Mirtazapine, 60 mg of Citalopram for depression and 25mg of Seroquel 3 x per day for anxiety.I was on Zyprexa for a few weeks prior to this being replaced by Seroquel as Zyprexa was not working effectively.My psychiatrist prescribed the Seroquel last Wednesday and I have been taking it since then.As he is on holidays for 3 weeks he said I may need to double the dose and to check in with my GP in approximately a week regarding the Seroquel.I have booked the appointment with my GP for this Friday.
I am finding that the 25mg 3 times daily is not sufficient to stop the anxiety as Its getting to the point where the anxiety is stopping me leaving the house.
My question is, is it reasonable and safe to double the dose now ? (and I will still see my GP on Friday) I
currently notice light sedation.Should I expect the sedation to increase if I go to 50mg three times daily ?
Thank you
I am finding that the 25mg 3 times daily is not sufficient to stop the anxiety as Its getting to the point where the anxiety is stopping me leaving the house.
My question is, is it reasonable and safe to double the dose now ? (and I will still see my GP on Friday) I
currently notice light sedation.Should I expect the sedation to increase if I go to 50mg three times daily ?
Thank you
Brief Answer:
Yes sedation will increase likely, increase dose slowly
Detailed Answer:
Hello,
Thanks for writing back.
Frankly speaking you should not double the dose directly and not also without informing doctor.
I agree that your treating doctor has told to double the dose if no improvement. It is not like that you should double the dose straight away. If you are facing sedation at 75 mg dose, at 150 mg sedation will be more after sudden doubling of the dose.
If I were your treating doctor, I would like to increase 25 mg every three days. You should add 25 mg more to your current night dose. If you do not face any trouble in three days, increase more 25 mg to noon dose. Discuss about this with your GP.
Other point is to use sustain release preparation of seroquel when you are taking more than 100 mg rather than plain tablet.SR preparation causes less or no sedation.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Yes sedation will increase likely, increase dose slowly
Detailed Answer:
Hello,
Thanks for writing back.
Frankly speaking you should not double the dose directly and not also without informing doctor.
I agree that your treating doctor has told to double the dose if no improvement. It is not like that you should double the dose straight away. If you are facing sedation at 75 mg dose, at 150 mg sedation will be more after sudden doubling of the dose.
If I were your treating doctor, I would like to increase 25 mg every three days. You should add 25 mg more to your current night dose. If you do not face any trouble in three days, increase more 25 mg to noon dose. Discuss about this with your GP.
Other point is to use sustain release preparation of seroquel when you are taking more than 100 mg rather than plain tablet.SR preparation causes less or no sedation.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks Dr Solanki
Just to clarify, if I were your patient is this correct -
Take 50mg first night (instead of current 25mg) every night and if ok in 3 days increase the current 25mg noon dose to 50mg.When should I adjust the morning dose ?
When you said " if everything ok" we're you referring to increased sedation being ok ?
Would it be best to use the extended release for any 50mg dosage.eg If I start tonight ?My son is on the extended release so I have access to them.
Is it ok to use a mix of extended release and immediate release eg While I am titrating up is it ok to use extended release at night but still use 25mg immediate release for the 25mg doses ?
Dr Solanki. The current dose is definitely not handling my anxiety.It is really overwhelming and stopping me functioning.Just walking around the house is an effort when the anxiety has me in its grip.Therefore would an increase in dose likely handle this much better ? Thank you in advance Regards XXXX
Just to clarify, if I were your patient is this correct -
Take 50mg first night (instead of current 25mg) every night and if ok in 3 days increase the current 25mg noon dose to 50mg.When should I adjust the morning dose ?
When you said " if everything ok" we're you referring to increased sedation being ok ?
Would it be best to use the extended release for any 50mg dosage.eg If I start tonight ?My son is on the extended release so I have access to them.
Is it ok to use a mix of extended release and immediate release eg While I am titrating up is it ok to use extended release at night but still use 25mg immediate release for the 25mg doses ?
Dr Solanki. The current dose is definitely not handling my anxiety.It is really overwhelming and stopping me functioning.Just walking around the house is an effort when the anxiety has me in its grip.Therefore would an increase in dose likely handle this much better ? Thank you in advance Regards XXXX
Brief Answer:
Morning dose after consulting GP
Detailed Answer:
Hello XXXXXXX
Thanks for follow up queries.
Yes you are right you should first increase night dose from 25 to 50. As it is night dose, you will go through sedation during night sleep. So I mean, if no other side effect (everything ok), you can increase more dose.
Your appointment on Friday means after 3 days. After that you can increase morning dose. It is better to inform local doctor about changing/increasing the dose. If any serious side effect occurs by chance, you can get immediate help.
Yes, it is good to take 50 mg dose in extended release formation.
It is also okay to use plain and ER formation simultaneously.
Yes increasing dose is going to help you to curtail your anxiety likely. But increase the dose under your GP's medical supervision.
In anxiety disorder use of seroquel is mostly off label and with other medicines. XR/ER preparation is more useful. Dose can be increased up to 300 mg.
All the best and wish you early stability,
Regards,
Dr.Chintan Solanki.
Morning dose after consulting GP
Detailed Answer:
Hello XXXXXXX
Thanks for follow up queries.
Yes you are right you should first increase night dose from 25 to 50. As it is night dose, you will go through sedation during night sleep. So I mean, if no other side effect (everything ok), you can increase more dose.
Your appointment on Friday means after 3 days. After that you can increase morning dose. It is better to inform local doctor about changing/increasing the dose. If any serious side effect occurs by chance, you can get immediate help.
Yes, it is good to take 50 mg dose in extended release formation.
It is also okay to use plain and ER formation simultaneously.
Yes increasing dose is going to help you to curtail your anxiety likely. But increase the dose under your GP's medical supervision.
In anxiety disorder use of seroquel is mostly off label and with other medicines. XR/ER preparation is more useful. Dose can be increased up to 300 mg.
All the best and wish you early stability,
Regards,
Dr.Chintan Solanki.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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