I’m wondering if anyone here has some experience with or some information about timing of meds. I am going to speak to the psychiatrist about it before changing anything but before I do, would appreciate any opinions or advice from personal experiences.

My daughter is on Seroquel (Quetiapine) 350mg per day. Originally we were told 100mg in the morning, 100mg 6 hours later and 125mg in the evening. As my daughter is not reliably up and awake before 8.00am that means the dose times were 8.00am, 2.00 pm and 8.00pm.

However, the side effect of that was that the evening dose was dropping out of her system by about 2.00am and we had some really problematic nights. ie she would wake about 2.00am or 3.00am and would have a lot of trouble dropping off again. She ALWAYS calls me when she can’t sleep and sometimes this was a couple of times a night. It was just like having a young baby again and really ran us both ragged. Then of course, she would wake – or rather have to be woken next morning at 8.00am, tired and cranky.

I spoke to her psychiatrist about this after it had gone on some months and he said to up the evening dose to 150mg. That really didn’t help matters. The stuff seems to be out of her system after the 6 hours regardless of how much the dosage is.

So, I started changing the dosage times. I moved the morning dose to about 8.30am, the next dose to 2.30pm and then delayed the night time dose to as late as possible – generally at bedtime which would be about 11.00pm or later. Doing that meant that most nights she slept through. However, of course that means that the afternoon dose is starting to wear off by about 9.00pm and it can be a bit “dodgy” riding it out until bedtime. You can see her getting edgier and edgier from about 8.00pm onwards.

So, on three doses a day we can have calm evenings but disturbed nights OR a decent night’s sleep and touchy evenings. Quite honestly I don’t know which is worse !

WHAT I am wondering about and where I would appreciate any advice or suggestions, is whether it would be feasible to divide the meds into FOUR doses ? The wear-off time is about 6 hours and there are 24 hours in a day. . . . . so divided into 3 doses is almost bound to create ONE long period where her levels of meds are quite low. I was thinking of somehow dividing the daily total of 350mg into four doses , perhaps 100mg morning, afternoon and evening (8.00am, 2.00pm and 8.00pm) and then the 50mg at bedtime about 11.00pm – hopefully to top up the 8.00pm dose which would be halfway through by bedtime, enough to see her through the night.

I don’t want to just tinker for the sake of it, but this is starting to nag at me because the medication is right for my daughter but just not quite right as regards timing. There is still this “breakthrough” as the levels go down. Of course a sustained release version would be fantastic but there isn’t one for this medication – well not that I’ve heard of. Maybe there is in the US ? In which case it wouldn’t be HERE for at least another decade.

Any thoughts or advice would be really appreciated !!