Can Seroquel (quetiapine) cause retrograde ejaculation?

Quetiapine and Retrograde Ejaculation

Yes, quetiapine (Seroquel) can cause retrograde ejaculation, as documented in case reports, though it is not a commonly reported side effect of this medication. 1

Mechanism and Evidence

Quetiapine's ability to cause retrograde ejaculation likely stems from its effects on the autonomic nervous system. While the FDA label for quetiapine does not specifically list retrograde ejaculation as a known adverse effect 2, there is clinical evidence supporting this association:

• A case report published in BMJ Case Reports (2019) specifically documented retrograde ejaculation associated with quetiapine use in a 25-year-old man with first-episode psychosis 1
• This appears to be similar to other antipsychotics that have been reported to cause retrograde ejaculation, including thioridazine, risperidone, iloperidone, and clozapine 1, 3

Understanding Retrograde Ejaculation

Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of being expelled through the urethra. This happens when the bladder neck does not close properly during ejaculation, causing:

• Dry or reduced-volume ejaculation
• Cloudy urine after sexual activity (due to presence of semen)
• Potential fertility issues

Risk Factors and Related Medications

Several medication classes are known to cause retrograde ejaculation:

• Antipsychotics (including quetiapine, as documented) 1, 3
• Antidepressants, particularly SSRIs and tricyclics 4, 5
• Alpha-blockers used for hypertension or prostate conditions
• Other conditions that increase risk include:
  • Diabetic autonomic neuropathy 5
  • Neurological disorders affecting spinal pathways 5
  • Previous retroperitoneal or pelvic surgery

Management Options

If retrograde ejaculation occurs with quetiapine and is problematic for the patient:

1. Medication adjustment:

   • Consider dose reduction if clinically appropriate (this resolved the issue in one of the documented cases) 1
   • Evaluate if switching to a different antipsychotic with potentially fewer sexual side effects is feasible

2. Pharmacological treatment:

   • Low-dose imipramine has been successfully used to treat quetiapine-associated retrograde ejaculation 1
   • Imipramine (25-50 mg daily) has shown efficacy in treating retrograde ejaculation from various causes 6
   • Pseudoephedrine (60 mg every 6 hours) has also shown benefit in some cases of retrograde ejaculation 7

Clinical Implications

When a patient on quetiapine reports dry ejaculation or reduced ejaculate volume:

• Confirm the diagnosis by checking post-ejaculatory urinalysis for presence of sperm
• Discuss the importance of medication adherence despite this side effect
• Consider treatment options if fertility is a concern or if the side effect significantly impacts quality of life
• Balance the need for psychiatric symptom control with sexual function concerns

Important Considerations

• Sexual side effects like retrograde ejaculation may lead to medication non-adherence and should be addressed proactively
• This side effect appears less common with quetiapine than with some other antipsychotics, but can still occur
• The condition is generally reversible upon medication discontinuation or dose adjustment 1
• For patients concerned about fertility, sperm retrieval from urine is possible if medication changes are not feasible

While retrograde ejaculation itself is not dangerous, it can significantly impact quality of life and reproductive potential, warranting appropriate clinical attention and management.