autumnal
Enlightened
- Feb 4, 2020
- 1,950
Dear All,
To answer the question about using Quetiapine (Seroquel) as an antiemetic for the SN method, I am often referring people back to a mishmash of my various posts and responses from others. To make this less confusing, I'm going to collate my opinions here. It also begins with a basic explanation of SN and antiemetics.
SN and nausea/vomiting
Taking SN can lead to nausea or vomiting. This is the instinctive reaction of the body to detecting a poison in the stomach and trying to expel it to keep us alive. As well as the other important steps in the SN protocol (such as fasting), taking anti-nausea medication can help prevent this. This class of medications are called antiemetics (from 'emesis', the medical term for vomiting).
Antiemetics
There are a number of different types of antiemetics, which target different kinds of nausea, such as from motion sickness, chemotherapy, pregnancy or general anaesthetic. In the case of antiemetics that work with SN, the specific subtype are called dopamine (D2) antagonists. The main example of this is a medicine called metoclopramide (or 'meto' for short).
Note that other types of antiemetics are not interchangeable for dopamine (D2) antagonists. This is because they target different kinds of nausea and have different mechanisms of action. So medications for travel sickness or morning sickness will not reduce nausea from SN. Not even slightly or a little or better than nothing. Not at all.
The Peaceful Pill Handbook (PPH) is a publication written by two medical doctors who specialise in euthanasia. It recommends taking metoclopramide as part of the SN protocol to help prevent nausea and vomiting. This is the only antiemetic it recommends.
Stan's Guide ('the guide') is a resource written by an experienced member of this forum. It suggests additional antiemetics that work with SN. These are:
Additionally, the guide also suggests certain antipsychotics can serve the same purpose.
Certain antipsychotics as alternatives to antiemetics
The only viable alternative to taking dopamine (D2) antagonist antiemetics is to take certain antipsychotic medications that also have antiemetic effects as an additional side effect. These are antipsychotics which target the dopamine (D2) receptors in the brain. The guide lists 13 such medications:
The most commonly prescribed of these is quetiapine (Seroquel), which is why it is the subject of the most forum questions and the focus of this guide.
Dosage of quetiapine required
Per Stan's Guide, quetiapine only works as an anti-emetic if you are taking it regularly, to allow levels of the medication to build up and be maintained. It does not work as an anti-emetic if taken as a once-off or single dose only as part of the SN protocol.
Everything else described so far is uncontroversial and widely-agreed on the forum. However, the one aspect that has less consensus is what (ongoing) dosage of quetiapine is required to have antiemetic effects. Quetiapine can be prescribed in doses anywhere between 25mg and 800mg. This is a very wide range of dosages. Because quetiapine was not created with the intention of being an antiemetic, there is not a heap of research on what dosage provides this particular side effect. To my knowledge, there is only one online resource that details this. It states:
This resource clearly states that quetiapine only targets dopamine (D2) receptors at a dosage of 300mg or higher. Because dopamine receptors are those which need to be targeted to reduce nausea from SN, it would appear that quetiapine only reduces nausea from SN when taken in quantities of 300mg or higher.
While the above is admittedly only a single resource, it appears to be the only found resource addressing this topic so far. It is therefore the closest thing to a definitive answer as to what dosage of quetiapine is needed with SN.
Once again, note that this will not work if taken as a single or once-off dosage. You need to be taking quetiapine at a dosage of 300mg or more for a long enough period for the medication to build up these levels. If you are already taking 300mg or higher on the direction of your doctor, then you are in luck and do not need to do anything further.
Note that to people not familiar with pharmacology, it may seem strange and counter-intuitive that a lower dose of a medicine could target one thing, but a higher dose could target something relatively different. Most people understand medicines which have either a threshold effect (i.e. one 500mg paracetemol/acetaminophen won't significantly reduce pain in adults, you need to take two [1,000mg] of them) or an increasing effect (four Valium will probably put you to sleep for longer than two Valium). However, due to the complexities of neurotransmitters in the brain, quetiapine does in fact have this dose-targeted effect. It is perhaps a lack of understanding of this principle which may have led to previous debates on this forum, where people have assumed that a lower dose of quetiapine should intuitively still provide a (possibly lower but still useful) degree of antiemetic effect. However, this is not the case.
----- Everything from here onwards is my personal opinion, and is not the view of the PPH nor Stan's Guide -----
Commencing and titrating quetiapine dosage
There are three situations where you may not already be taking 300mg or higher of quetiapine, and my recommendations for each:
1. You are taking quetiapine, but at a dosage lower than 300mg.
2. You are not taking quetiapine, but have taken it in the past.
3. You have never taken quetiapine.
Titration dosage of quetiapine
To increase from your current lower dose (or zero) of quetiapine, gradually increasing your dosage as follows will help minimise the likelihood and severity of side effects.
REF: Drugs.com > Quetiapine > Dosage > Usual Adult Dose for Schizophrenia (detail) [or Archived version]
How long to take quetiapine to gain antiemetic effects
It is not specifically documented how long quetiapine takes to product antiemetic effects. The following may provide some guidance:
In the absence of any source to suggest that the antiemetic effects of quetiapine are instantaneous or rapid in onset, my personal opinion would be to take quetiapine for at least two weeks, and ideally for six weeks before depending on it as an antiemetic for the SN method.
Conclusions
This guide has been an admittedly very wordy way of getting across a relatively simple fact, however I believe it is important to be thorough in explanation and transparent as to resources used in providing this information. I hope people find it useful, and it is built upon or revised in future as appropriate.
– Autumnal
Disclaimer: I have some academic background in healthcare, but I am not a healthcare professional.
Appendix
Additional drug names for search results:
Quetiapine = Seroquel; Seroquel XR; Temprolide; Xeroquel; Ketipinor
To answer the question about using Quetiapine (Seroquel) as an antiemetic for the SN method, I am often referring people back to a mishmash of my various posts and responses from others. To make this less confusing, I'm going to collate my opinions here. It also begins with a basic explanation of SN and antiemetics.
SN and nausea/vomiting
Taking SN can lead to nausea or vomiting. This is the instinctive reaction of the body to detecting a poison in the stomach and trying to expel it to keep us alive. As well as the other important steps in the SN protocol (such as fasting), taking anti-nausea medication can help prevent this. This class of medications are called antiemetics (from 'emesis', the medical term for vomiting).
Antiemetics
There are a number of different types of antiemetics, which target different kinds of nausea, such as from motion sickness, chemotherapy, pregnancy or general anaesthetic. In the case of antiemetics that work with SN, the specific subtype are called dopamine (D2) antagonists. The main example of this is a medicine called metoclopramide (or 'meto' for short).
The Peaceful Pill Handbook (PPH) is a publication written by two medical doctors who specialise in euthanasia. It recommends taking metoclopramide as part of the SN protocol to help prevent nausea and vomiting. This is the only antiemetic it recommends.
Stan's Guide ('the guide') is a resource written by an experienced member of this forum. It suggests additional antiemetics that work with SN. These are:
- Dromperidone
- Metoclopramide
- Olanzapine
- Alizapramide
- Chlorpromazine
- Prochlorperazine
Certain antipsychotics as alternatives to antiemetics
The only viable alternative to taking dopamine (D2) antagonist antiemetics is to take certain antipsychotic medications that also have antiemetic effects as an additional side effect. These are antipsychotics which target the dopamine (D2) receptors in the brain. The guide lists 13 such medications:
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The most commonly prescribed of these is quetiapine (Seroquel), which is why it is the subject of the most forum questions and the focus of this guide.
Dosage of quetiapine required
Per Stan's Guide, quetiapine only works as an anti-emetic if you are taking it regularly, to allow levels of the medication to build up and be maintained. It does not work as an anti-emetic if taken as a once-off or single dose only as part of the SN protocol.
Everything else described so far is uncontroversial and widely-agreed on the forum. However, the one aspect that has less consensus is what (ongoing) dosage of quetiapine is required to have antiemetic effects. Quetiapine can be prescribed in doses anywhere between 25mg and 800mg. This is a very wide range of dosages. Because quetiapine was not created with the intention of being an antiemetic, there is not a heap of research on what dosage provides this particular side effect. To my knowledge, there is only one online resource that details this. It states:
Quetiapine - The Drug Classroom
5. Chemistry & Pharmacology
[...]
Its pharmacological profile varies by dose. At low doses (~25 mg), it's mainly an H1 antagonist. Moderate doses (50-100+ mg) incorporate greater serotonin receptor antagonism. High doses (300+ mg) recruit D2 antagonism. [my emphasis]
This resource clearly states that quetiapine only targets dopamine (D2) receptors at a dosage of 300mg or higher. Because dopamine receptors are those which need to be targeted to reduce nausea from SN, it would appear that quetiapine only reduces nausea from SN when taken in quantities of 300mg or higher.
While the above is admittedly only a single resource, it appears to be the only found resource addressing this topic so far. It is therefore the closest thing to a definitive answer as to what dosage of quetiapine is needed with SN.
Once again, note that this will not work if taken as a single or once-off dosage. You need to be taking quetiapine at a dosage of 300mg or more for a long enough period for the medication to build up these levels. If you are already taking 300mg or higher on the direction of your doctor, then you are in luck and do not need to do anything further.
Note that to people not familiar with pharmacology, it may seem strange and counter-intuitive that a lower dose of a medicine could target one thing, but a higher dose could target something relatively different. Most people understand medicines which have either a threshold effect (i.e. one 500mg paracetemol/acetaminophen won't significantly reduce pain in adults, you need to take two [1,000mg] of them) or an increasing effect (four Valium will probably put you to sleep for longer than two Valium). However, due to the complexities of neurotransmitters in the brain, quetiapine does in fact have this dose-targeted effect. It is perhaps a lack of understanding of this principle which may have led to previous debates on this forum, where people have assumed that a lower dose of quetiapine should intuitively still provide a (possibly lower but still useful) degree of antiemetic effect. However, this is not the case.
----- Everything from here onwards is my personal opinion, and is not the view of the PPH nor Stan's Guide -----
Commencing and titrating quetiapine dosage
There are three situations where you may not already be taking 300mg or higher of quetiapine, and my recommendations for each:
1. You are taking quetiapine, but at a dosage lower than 300mg.
You may choose to gradually increase your dosage until it reaches 300mg. Note that this may increase side effects or interactions with your other medications. See the titration diagram below.
2. You are not taking quetiapine, but have taken it in the past.
You may choose to resume taking the drug, and to gradually increase your dosage until it reaches 300mg. Ideally, you would do so under the guidance of a doctor, for example by saying the symptoms you were originally prescribed quetiapine for have returned and you wish you resume the medication. All medications have side effects and interactions with other drugs, and these are best determined by a doctor. For dose increases, follow your doctor's instructions, or otherwise see the titration diagram below.
3. You have never taken quetiapine.
You may choose to obtain the drug and to gradually increase your dosage until it reaches 300mg. See titration diagram below. You may choose to legitimately obtain it from a doctor following the suggestions in situation 2 above. However, it is strongly not recommended to take any medication which has not been specifically prescribed for you. All medications have side effects and interactions with other drugs, and these are best determined by a doctor. If you have neither quetiapine nor traditional antiemetic drugs, it is safer and easier to obtain and take a single dose of an antiemetic than to start taking quetiapine without guidance from a doctor.
Titration dosage of quetiapine
To increase from your current lower dose (or zero) of quetiapine, gradually increasing your dosage as follows will help minimise the likelihood and severity of side effects.
REF: Drugs.com > Quetiapine > Dosage > Usual Adult Dose for Schizophrenia (detail) [or Archived version]
How long to take quetiapine to gain antiemetic effects
It is not specifically documented how long quetiapine takes to product antiemetic effects. The following may provide some guidance:
6. Response and Effectiveness
Peak levels of Seroquel are reached 1.5 hours after administration of immediate-release tablets or 6 hours after administration of extended-release tablets. Sedative effects happen almost immediately; however, it may take up to two to three weeks to see some improvement in other symptoms and up to six weeks for the full effects to be seen [my emphasis].
In the absence of any source to suggest that the antiemetic effects of quetiapine are instantaneous or rapid in onset, my personal opinion would be to take quetiapine for at least two weeks, and ideally for six weeks before depending on it as an antiemetic for the SN method.
Conclusions
This guide has been an admittedly very wordy way of getting across a relatively simple fact, however I believe it is important to be thorough in explanation and transparent as to resources used in providing this information. I hope people find it useful, and it is built upon or revised in future as appropriate.
– Autumnal
Disclaimer: I have some academic background in healthcare, but I am not a healthcare professional.
Appendix
Additional drug names for search results:
Quetiapine = Seroquel; Seroquel XR; Temprolide; Xeroquel; Ketipinor
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