Can quetiapine (Seroquel) cause hot flashes, and what are the recommended management steps?

Quetiapine Does Not Cause Hot Flashes—It May Actually Reduce Them

Quetiapine (Seroquel) is not known to cause hot flashes as an adverse effect. In fact, preliminary evidence suggests it may reduce vasomotor symptoms including hot flashes in some populations, though this is not an FDA-approved indication 1.

What the FDA Label Says About Quetiapine Side Effects

The FDA-approved prescribing information for Seroquel does not list hot flashes as a recognized adverse effect 2. The most common side effects include:

• Somnolence (18-57% depending on indication)
• Dizziness and orthostatic hypotension (15-27%)
• Weight gain (common, requires monitoring)
• Metabolic effects (hyperglycemia, dyslipidemia)
• Anticholinergic effects (dry mouth, constipation)

The FDA label specifically warns about body temperature dysregulation—but this refers to impaired ability to reduce core body temperature (risk of hyperthermia), not hot flashes 2.

Evidence That Quetiapine May Actually Help Hot Flashes

One pilot study examined quetiapine extended-release (150-300 mg/day) in perimenopausal and early postmenopausal women with depression and significant menopause-related symptoms 1. Results showed:

• Significant reduction in hot flash interference with daily functioning (P < 0.01)
• Improvement in overall menopause symptoms on the Greene Climacteric Scale
• 17 of 24 subjects responded to treatment

However, this was a small, open-label study without a control group, and quetiapine is not FDA-approved for vasomotor symptoms.

If Your Patient Reports Hot Flashes While Taking Quetiapine

Consider these alternative explanations:

1. Underlying menopause or perimenopause - The most common cause of hot flashes in women aged 40-60 3

2. Other medical conditions to exclude:

   • Hyperthyroidism
   • Pheochromocytoma
   • Carcinoid syndrome
   • Panic disorder
   • Diabetes

3. Concomitant medications:

   • Tamoxifen or other antiestrogens
   • Selective estrogen receptor modulators (SERMs)
   • Other medications that can trigger vasomotor symptoms 3

4. Withdrawal from other medications - If quetiapine was started after discontinuing another psychotropic

Management Approach

Do not discontinue quetiapine based solely on hot flashes unless there is clear temporal relationship and no other explanation.

First-line evidence-based treatments for hot flashes (if that's the actual problem):

• SSRIs/SNRIs: Paroxetine (FDA-approved for hot flashes), venlafaxine, desvenlafaxine, citalopram, escitalopram reduce hot flash frequency by 25-69% 4

  • Caution: Avoid paroxetine with tamoxifen due to drug interaction 4

• Gabapentin: 300-1200 mg (especially effective for nighttime symptoms) 4

• Pregabalin: 75-150 mg twice daily (65-71% reduction in hot flash scores) 4

• Hormone therapy: Most effective option but requires individualized risk-benefit assessment 4, 3

Important Safety Considerations for Quetiapine in Older Adults

If your patient is elderly, be aware that quetiapine carries significant risks in this population 5, 6:

• Increased mortality compared to trazodone (HR 3.1)
• Higher dementia risk compared to both trazodone (HR 8.1) and mirtazapine (HR 7.1)
• Increased fall risk (HR 2.8 vs trazodone)
• Cognitive impairment, particularly in patients with parkinsonism

These risks apply even at low doses used for insomnia 5.

Bottom Line

Hot flashes are not a recognized side effect of quetiapine. If a patient on quetiapine reports hot flashes, investigate other causes—particularly menopause, medical conditions, or other medications. The quetiapine itself is unlikely to be the culprit and may even provide some benefit for vasomotor symptoms in select patients, though this is not an established indication.