<s>[INST] Hello doctor, I have been on 200 mg Quetiapine IR for some time. Finding it after years of medication tweaking to truly keep my bipolar II symptoms in check, with no significant side effects. I ran out while traveling abroad. Though I have no means of obtaining a new prescription, I do have plenty of Seroquel XR (in 50, 150, and 200 mg dosages) with me. For two nights, I have tried taking a 200 mg XR pill in the evening. Unfortunately, I have gotten little to no sleep and am very concerned about sleep cycle disruptions, as they have always led to more severe symptoms in the past. Moreover, I feel the sedative effects throughout the following day, an impairment I simply cannot afford to deal with right now, as well as a more persistent general sense of anxiety and agitation. If I were to simply crush these pills into a powder, would I be able to take them as though they were immediate-release of the same dose? Or would doing so alter the medication's properties? I am aware of the medication guide's instruction against chewing or cutting the sustained-release pills in any way, but I wish to know what the actual effects of doing so would be. Any suggestions on minimizing related risks, like food or water consumption tips, titration from a lower dose, etc.? Thanks. [/INST] Hello. Let me enlighten you with the concept of IR and XR medication. IR medications mean immediate release; once you take the drug, its effects come in minutes and lasts few hours only. Most of the drugs are in IR form until we need them for some specific purpose. IR medications have a shorter half-life and need to be taken in multiple dosages in a day. XR medications mean extended release; once taken, the drug will be released slowly over a period so that a plateau state for serum drug level can be achieved for a longer period. XR medications have a gastro-resistant coating over it, which prevents them to get dissolved in gastric juices immediately, hence resulting in delayed release of the drug. XR medications have a longer half-life and can be taken once a day. However, breaking an XR drug into powder state will result in erratic release and erratic blood level. Hence, variable effects along with more side-effects. I can understand your problem, sleep disturbance is considered to be the utmost important early warning sign in bipolar disorders, and it needs to be treated as early as possible. In your case, you can opt a short acting benzodiazepine for sleep induction, as you have difficulty to fall asleep. Once sleep is induced, it can be maintained by Seroquel XR (Quetiapine) as well. Zolpidem 5 mg is a good medication for sleep induction. Besides this, you can try Nitrazepam 10 mg for the same purpose. Though Zolpidem has the least dependence potential, and it is the preferred choice. Besides this, follow sleep hygiene measures, they will be helpful over a long run and will help in maintaining healthy sleep-wake cycle without medications. Thank you. For more information consult a psychiatrist online --> </s>