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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by mannetje on March 5, 2001, at 23:35:26
My son takes 5mg respirdol to which his pdoc added seroquel [ 25mg for day 1; 50mg for day 2; then 75mg for day 3 ] The dose was to be increased to 200mgs. On the third day following the preceeding evening's dose of 75 mg my son had a fever of 100.4 degrees, was dizzy [ not orthostatic] and had pupilliary dilation[bilateral.] He called his pdoc who told my son that he should continue to increase the seroquel dosage as directed. My son said that he preferred not to continue with seroquel at which point his pdoc agreed that it was ok for him not to continue and to discontinue the seroquel immediately without slow reduction. In addition to these physical reations my son reported that he did not feel like himself, that he was slowed down and [this next again a physical reaction ] that he felt funny in his head like he felt when he took 6mgs respirdol some months ago.
From my reading it sounded like an anticholinergic effect. CAm, I would very much appreciate it if you would please comment on this. Thank You
Posted by Cam W. on March 6, 2001, at 6:40:48
In reply to Reaction to Seroquel - A question for CAm , posted by mannetje on March 5, 2001, at 23:35:26
Mannetje - transient fever is a side effect of Seroquel and occurs in about 2% of people (usually seen in people taking >150mg/day), but usually goes away after a couple of days. Also, dizziness is quite common, especially at the start of therapy and may even be partialy related to the fever. Dizziness and postural hypotension are 2 of the main reasons to titrate the dose of Seroquel slowly, as the doc had been doing.
The dizziness probably has more to do with the antihistminergic effects of Seorquel, as the drug doesn't appreciably bind to cholinergic receptors. The abrupt stopping of the Seroquel may have caused a cholinergic rebound effect with the Risperdal (this is just a guess), that manifested as "feeling slowed down". At such a low dose of Seroquel you wouldn't think that you would need to titrate down; usually that is reserved for when the dose is 600mg - 900mg daily. That funny feeling in his head should go away in a day or two.
The fever may be of the type seen with other antipsychotics, which is thought to be due to a disruption of the body's ability to reduce core body temperature. This usually happens upon exersion (eg exercise) where the body doesn't cool itself off properly. This is more commonly seen with the low potency traditional antipsychotics (eg higher dose chlorpromazine; esp when taking anticholinergics, as well) and is worsened when one becomes dehydrated in exersion situations.
Your son should see his doctor and have a blood test, just to see if he should maybe continue with the Seroquel, but titrate the dose slower. What he is experiencing may just be start-up side effects ans should go away after his body gets use to the drug. The problem is, is that it does take time to get use to the drug and some people think that these initial side effects will continue, which they probably will not. It would be a shame to stop a potentially useful durg and lose one more weapon against the disorder. A slower upward titration may be in order; ask the doctor about this.
Hope this helps - Cam
Posted by mannetje on March 6, 2001, at 14:16:44
In reply to Re: Reaction to Seroquel - A question for CAm » mannetje, posted by Cam W. on March 6, 2001, at 6:40:48
> Mannetje - transient fever is a side effect of Seroquel and occurs in about 2% of people (usually seen in people taking >150mg/day), but usually goes away after a couple of days. Also, dizziness is quite common, especially at the start of therapy and may even be partialy related to the fever. Dizziness and postural hypotension are 2 of the main reasons to titrate the dose of Seroquel slowly, as the doc had been doing.
>
> The dizziness probably has more to do with the antihistminergic effects of Seorquel, as the drug doesn't appreciably bind to cholinergic receptors. The abrupt stopping of the Seroquel may have caused a cholinergic rebound effect with the Risperdal (this is just a guess), that manifested as "feeling slowed down". At such a low dose of Seroquel you wouldn't think that you would need to titrate down; usually that is reserved for when the dose is 600mg - 900mg daily. That funny feeling in his head should go away in a day or two.
>
> The fever may be of the type seen with other antipsychotics, which is thought to be due to a disruption of the body's ability to reduce core body temperature. This usually happens upon exersion (eg exercise) where the body doesn't cool itself off properly. This is more commonly seen with the low potency traditional antipsychotics (eg higher dose chlorpromazine; esp when taking anticholinergics, as well) and is worsened when one becomes dehydrated in exersion situations.
>
> Your son should see his doctor and have a blood test, just to see if he should maybe continue with the Seroquel, but titrate the dose slower. What he is experiencing may just be start-up side effects ans should go away after his body gets use to the drug. The problem is, is that it does take time to get use to the drug and some people think that these initial side effects will continue, which they probably will not. It would be a shame to stop a potentially useful durg and lose one more weapon against the disorder. A slower upward titration may be in order; ask the doctor about this.
>
> Hope this helps - Cam
CAm,Thank you again for your help. My son stopped the seroquel and seems ok. What blood test should he take if he wants tio try it agian and does the pupilary dilation inidcate anthing that he should be concerned about? Thank You. This site is so helpful and comforting.
Posted by Cam W. on March 6, 2001, at 14:51:36
In reply to Re: Reaction to Seroquel - A question for CAm , posted by mannetje on March 6, 2001, at 14:16:44
Mannetje - I was just thinking out lod with the blood test idea. I was thinking just a genreal blood test to see if the fever was due to an infection or something like that.
As for the pupilary dilation; if it has stopped, I would maybe chalk it up to cholinergic rebound thing with the withdrawl of Seroquel. This would be an idiosyncratic effect, as Seroquel really doesn't directly affect cholinergic receptors, but may in a round about way through alpha-adrenergic receptors or some other receptor. This is only a guess though. I truly don't know what is going on, but if it isn't a sustained reaction, I'd hazard a guess as it being a mild withdrawl effect, most likely without long term consequences. What does the doc say about the pupilary dilation?
- Cam
Posted by mannetje on March 6, 2001, at 22:06:36
In reply to Re: Reaction to Seroquel - A question for CAm » mannetje, posted by Cam W. on March 6, 2001, at 14:51:36
> Mannetje - I was just thinking out lod with the blood test idea. I was thinking just a genreal blood test to see if the fever was due to an infection or something like that.
>
> As for the pupilary dilation; if it has stopped, I would maybe chalk it up to cholinergic rebound thing with the withdrawl of Seroquel. This would be an idiosyncratic effect, as Seroquel really doesn't directly affect cholinergic receptors, but may in a round about way through alpha-adrenergic receptors or some other receptor. This is only a guess though. I truly don't know what is going on, but if it isn't a sustained reaction, I'd hazard a guess as it being a mild withdrawl effect, most likely without long term consequences. What does the doc say about the pupilary dilation?
>
> - Cam
Thanks again CAm. My son will see the pdoc
Thurs. He had a similar [ second] reaction today, far less severe but with fever, pupilary dilation and dizziness. This is after one day without seroquel.To have been a withdrawl effect th e first time it seems that it would have to be an effect on the risperdol from the seroquel emptying given that the first reaction occured about two hours before what was to be his next dose of seroquel.[ the titering had been 25 1st day, 50 second day, 75 mg third day. It was on the evening of the fourth day just before he was to take 100mg that he had the reaciton] He was then fine the following day and made it to a half day in school, took a test, altho depressed until after a walk. Fine until again in the evening had fever, pupilary dilation,dizziness. He reports that it is less severe than the night before. Just seems scary to try the seroquel again without much closer supervision. Thanks again
This is the end of the thread.
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