Seroquel (Quetiapine) for Sleep? Here’s What You Need to Know
Medically reviewed by Erika Prouty, PharmD
Seroquel (quetiapine) is a second-generation (or atypical) antipsychotic or a drug used to treat certain mood disorders, such as schizophrenia and bipolar disorder.
While the US Food and Drug Administration (FDA) does not approve Seroquel for helping with sleep or treating insomnia, it is sometimes used off-label for this purpose. In clinical trials, Seroquel caused somnolence, or sleepiness, as a side effect in up to 57% of people.
This article will discuss the off-label use of Seroquel for sleep problems, including how it's used, dosage, side effects, and other treatments for insomnia.
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Seroquel for Sleep
The FDA approved Seroquel (quetiapine) to treat:
Schizophrenia in adults and adolescents 13-17 years of age
Bipolar I disorder manic episodes, as the only treatment or in addition to other agents like lithium or Depakote (divalproex)
Bipolar disorder depressive episodes
Sleepiness is a common side effect of the medication, so it may be helpful for those already taking it for a mental health condition who have trouble sleeping. Moreover, it may also improve sleep by relieving symptoms of the underlying condition.
However, it had not been approved to treat primary insomnia, a condition characterized by sleeping difficulties that aren't caused by medical or psychological reasons. Still, it is sometimes prescribed off-label in low doses for sleep problems.
What Is "Off-Label" Use?
When a healthcare provider uses an FDA-approved drug for an unapproved use, that use is considered off-label. When the FDA approves a drug for any use, they deem it safe for its intended uses. This doesn’t mean that the drug has no side effects but that its benefits outweigh the risks based on clinical trials.
However, providers can use their medical expertise to prescribe FDA-approved drugs for unapproved uses. This occurs if they determine that the drug is medically appropriate for you. They may do this because another drug is unavailable or you have tried other medications that have not worked.
Research on Seroquel for Insomnia
Sleepiness is a well-documented side effect of Seroquel in clinical trials. However, there is not enough information to recommend it as a sleep aid.
This is because the studies cannot distinguish between improved sleep as a result of treating the mental health condition or as a direct result of the drug.
Despite its growing popularity for off-label use, limited studies have been conducted to determine Seroquel's effectiveness in treating insomnia or improving sleep in otherwise healthy individuals.
One study evaluated the sleep quality of 14 healthy males over three nights in a row. They were treated with either a placebo, 25 milligrams (mg) of Seroquel, or 100 mg of Seroquel taken one hour before sleep.
According to the results, both doses of Seroquel significantly improved sleep quality, initiation, and duration.
Another study included just 13 people who received a placebo or 25 mg of Seroquel every night for two weeks. Trends were observed in the Seroquel group for improved sleep but were not considered statistically significant results, meaning it's possible the results occurred due to chance.
A couple more trials have been done that did not provide sufficient data to recommend Seroquel for the treatment of primary insomnia.
Seroquel Dosage for Sleep
The recommended dosage for Seroquel typically ranges from 100 mg to 800 mg per day, depending on the indication.
The most common doses of Seroquel used in clinical trials ranged from 25 mg to 300 mg once daily before bed. Some clinical trials recommend a starting dosage range from 50 mg to 150 mg per day.
Higher doses of Seroquel are associated with a higher risk of side effects, but even lower doses have been associated with side effects such as weight gain and increased triglyceride levels.
There is also a concern for people 65 years and older taking antipsychotic medications. Older people may experience more side effects and should start with a lower dose of Seroquel.
How to Take Seroquel Safely
Due to its sleep-promoting effects, avoid driving or other activities requiring focus or alertness after taking Seroquel until you know exactly how it will affect you.
For your first dose, try taking it at night when you don't have to be awake too early the next day. This is because it can cause grogginess in the morning.
Before taking Seroquel, have your blood sugar and lipid levels checked by a healthcare provider. You should also let your prescriber know if you have high or low blood pressure, abnormal thyroid hormone levels, and any blood abnormalities like low white blood cell count.
It’s best to avoid drinking alcohol while taking Seroquel, as it has the potential to worsen some side effects.
If you need to stop Seroquel, talk with your healthcare provider first. If you stop taking it suddenly, you may have a greater chance of side effects like trouble sleeping, nausea, and vomiting.
Does Seroquel Have a Potential for Abuse?
Seroquel is not known to cause euphoric effects, but it may still be abused. It is sometimes added to other illegal substances or street drugs in an attempt to enhance them or to counter some of their side effects.
The risk of abuse or misuse of Seroquel is not as high as other drugs that are often used to treat insomnia, such as benzodiazepines or Z-drugs, but the risk of abuse should be weighed based on individual factors like past abuse or misuse of other drugs or addictive personalities.
What Are "Z-Drugs?"
Z-drugs refer to a group of nonbenzodiazepine hypnotic medications approved to treat insomnia, known as:
Lunesta (eszopiclone)
Sonata (zaleplon)
Ambien (zolpidem)
Can Seroquel Cause Rebound Insomnia?
Seroquel, along with other antipsychotic drugs, may cause withdrawal symptoms, including rebound insomnia when you stop taking them. Rebound insomnia can sometimes be even worse than the insomnia you had before you started taking the medication.
This is why it’s important to talk with your healthcare provider before stopping Seroquel. It should be tapered slowly, meaning the dose you’re taking slowly gets decreased.
Side Effects With Seroquel
Seroquel tends to cause a wide range of side effects involving multiple systems in the body. This is a large part of why it is not the ideal drug for people who have insomnia without the presence of additional conditions that Seroquel is approved or used more often to treat.
Potential side effects include:
Headache
Agitation
Somnolence
Dizziness
Dry mouth
Constipation
Metabolic changes such as high blood sugar, high lipid levels, and weight gain
Tardive dyskinesia, involuntary movements of facial muscles
Hypotension or low blood pressure
Blood cell effects such as leukopenia, neutropenia, and agranulocytosis
QT prolongation, which may make heart issues such as arrhythmias more likely to develop
Seizures
Potential for cognitive and motor impairment
Are There Alternatives to Seroquel for Sleep?
Before taking medication, you should try to practice the best possible sleep hygiene or sleep habits, which can help improve your insomnia. Some examples include:
Maintain a consistent sleep and wake schedule
Engage in regular exercise
Avoid caffeine, alcohol, heavy meals, and excessive light exposure late in the day
There are some herbal remedies and dietary supplements that may also help you sleep. However, they should be used with caution. Some herbal agents interact with other herbals and prescription medications, so please make sure your healthcare provider knows all the herbal or dietary supplements and medications you take.
Herbal products are also not regulated by the FDA and may have variable quality control processes upon manufacturing, which may result in inconsistent and unpredictable effectiveness.
Some options to look into that could potentially help include:
California poppy
Saffron extract
Melatonin supplements, which contain a synthetic form of the naturally occurring sleep hormone your body produces in response to darkness, are commonly used as a sleep aid. However, data does not support their use for treating insomnia.
Finally, some medications that are either approved for sleep or are sometimes used off-label to help with sleep include:
Z drugs such as eszopiclone, Sonata (zaleplon), and Ambien (zolpidem), which can be habit-forming and carry a moderate abuse potential
Benzodiazepines, which also have a high abuse risk and are highly addictive
Trazodone, a miscellaneous antidepressant
Rozerem (ramelteon), a melatonin receptor agonist
Belsomra (suvorexant), a dual orexin receptor antagonist
Summary
While Seroquel often causes sleepiness, it is not a sleeping pill. There isn't enough evidence to recommend its use for treating primary insomnia. Still, it is sometimes prescribed off-label for sleeping problems, although it's not the best choice for everyone.
Additionally, Seroquel doesn't come without risks, as it has a broad side effect profile. These include metabolic, heart, and hematologic (blood) effects.
Seroquel may be helpful if it treats the underlying condition affecting your sleep. Otherwise, other options are available to help with sleep problems if you have insomnia and are otherwise healthy.
If you struggle with insomnia but can’t figure out the cause of your sleep issues, talk with your healthcare provider about other available interventions for improvement.
Read the original article on Verywell Health.
