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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Slurred Speech And Insomnia While On Mirtazatine And Seroquell?

Hi Im concerned about a 57 yr old smoker , etoh abuse hx, hx of MI , ministroke, recently discharged from ANN ARBOR VA INPATIENT psych unit. I was also a pt. I have been an RN for 34 yrs.Me, Garden variety bipolar relatively stable, retired fom the prison. He hasnt slept in 2 days has drank 8 beers and smoked a little grass today . His speech is slightly slurred and he is dwelling on pastsounds resentful. Lives alone takes Mirtazatine, 400 seroquell, dilantin and Keppra he repeted his dose of seroquel last noc he sounds slightly manic .sleep pattern while inpt 3-4 hrs I think he needs to be seen tonight what are your thoughts thanks jjeff
Fri, 28 Aug 2015
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Psychiatrist 's  Response
Hello thanks for asking from HCM for your health related queries

I can understand your concern. He is an old smoker and have history of cardiovascular problems. The medicines are Mirtazapine, Quetiapine, Phenytoin and Levatiracetam. Out of these medicines he is taking high doses of Quetiapine. Quetiapine is a second generation antipsychotic drug and even though considered as safe still at high doses might result in extrapyramidal side effects (EPS). The symptoms he is showing like slurring of voice is most probably due to these side effects and should be investigated properly. For the treatment I'd advise you to take him to a doctor immediately and ask for re-evaluation.

Dose reduction can help but this might increase the problems of insomnia. In such case drugs like Clonazepam or Lorazepam can be added. For persistent slurring drugs like Trihexyphenidyl or Benzotropin can be used. Please consult a psychiatrist for prescription of these drugs. With dose adjustments his sleep will improve.

Thanks, Hope this helps you. Take care

Dr. Seikhoo Bishnoi,
Psychiatrist.
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What Causes Slurred Speech And Insomnia While On Mirtazatine And Seroquell?

Hello thanks for asking from HCM for your health related queries I can understand your concern. He is an old smoker and have history of cardiovascular problems. The medicines are Mirtazapine, Quetiapine, Phenytoin and Levatiracetam. Out of these medicines he is taking high doses of Quetiapine. Quetiapine is a second generation antipsychotic drug and even though considered as safe still at high doses might result in extrapyramidal side effects (EPS). The symptoms he is showing like slurring of voice is most probably due to these side effects and should be investigated properly. For the treatment I d advise you to take him to a doctor immediately and ask for re-evaluation. Dose reduction can help but this might increase the problems of insomnia. In such case drugs like Clonazepam or Lorazepam can be added. For persistent slurring drugs like Trihexyphenidyl or Benzotropin can be used. Please consult a psychiatrist for prescription of these drugs. With dose adjustments his sleep will improve. Thanks, Hope this helps you. Take care Dr. Seikhoo Bishnoi, Psychiatrist.