Does Seroquel (quetiapine) affect blood pressure?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 2, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Quetiapine's Effects on Blood Pressure

Yes, Seroquel (quetiapine) can significantly affect blood pressure, primarily causing orthostatic hypotension, especially during initial dose titration due to its α1-adrenergic antagonist properties. 1

Mechanism and Prevalence

Quetiapine's impact on blood pressure is well-documented in its FDA labeling:

  • Causes orthostatic hypotension associated with dizziness, tachycardia, and syncope in some patients
  • Syncope was reported in 1% of patients treated with quetiapine (compared to 0.2% on placebo)
  • These effects are most pronounced during the initial dose-titration period 1

The mechanism is primarily related to quetiapine's α1-adrenergic antagonist properties, which cause vasodilation and subsequent drop in blood pressure.

Risk Factors

Certain patient populations are at higher risk for quetiapine-induced hypotension:

  • Patients with known cardiovascular disease
  • History of myocardial infarction or ischemic heart disease
  • Heart failure or conduction abnormalities
  • Cerebrovascular disease
  • Conditions predisposing to hypotension (dehydration, hypovolemia)
  • Patients on antihypertensive medications 1
  • Elderly patients 2

Blood Pressure Effects in Special Populations

Children and Adolescents

In placebo-controlled trials with children and adolescents:

  • 15.2% experienced increases in systolic blood pressure (≥20 mmHg)
  • 40.6% experienced increases in diastolic blood pressure (≥10 mmHg) 1

Elderly Patients

Elderly patients are particularly vulnerable to quetiapine's hypotensive effects due to:

  • Age-related changes in pharmacokinetics and pharmacodynamics
  • Multiple comorbidities (heart disease, hypertension, diabetes)
  • Different receptor binding profiles 2

A case report documented an elderly man with heart disease who developed symptomatic bradycardia and hypotension while taking quetiapine, with improvement after dose reduction and withdrawal 2.

Clinical Management

To minimize the risk of orthostatic hypotension and syncope:

  1. Start with low doses: Initial dose should be limited to 25 mg twice daily 1
  2. Gradual titration: If hypotension occurs during titration, return to the previous dose 1
  3. Monitor blood pressure: Regular monitoring is essential, especially during dose adjustments
  4. Fall risk assessment: Complete fall risk assessments at initiation and regularly during treatment 1
  5. Use caution with antihypertensive medications: Be aware of potential additive effects

Comparison with Other Psychotropic Medications

Unlike quetiapine, some antidepressants like selective serotonin reuptake inhibitors (SSRIs) have limited effects on the autonomic system and lower impact on blood pressure, making them safer options for patients with cardiovascular concerns 3.

Long-term Considerations

Recent research suggests caution when using even low-dose quetiapine in older adults, as it's associated with significantly higher rates of mortality, dementia, and falls compared to alternatives like trazodone 4.

Conclusion

When prescribing quetiapine, clinicians should:

  • Consider the patient's cardiovascular status
  • Start with low doses and titrate slowly
  • Monitor blood pressure regularly, especially during dose adjustments
  • Be vigilant for signs of orthostatic hypotension
  • Consider alternative medications in high-risk patients
  • Educate patients about potential symptoms of hypotension (dizziness, lightheadedness)

This careful approach can help minimize the risk of adverse cardiovascular events while still providing effective treatment.

References

3
Research

Antidepressant Drugs Effects on Blood Pressure.

Frontiers in cardiovascular medicine, 2021

Related Questions

Would 37.5 mg of quetiapine (Seroquel) at bedtime be a suitable alternative to 50 mg for managing sleep and minimizing adverse effects such as excessive sedation and orthostatic hypotension?
Can benazapril (Angiotensin-Converting Enzyme (ACE) inhibitor) and fluoxetine (selective serotonin reuptake inhibitor (SSRI)) be taken together?
Is Quetiapine (quetiapine) 25mg twice a day (BID) safe for a 59-year-old male with Lewy body dementia experiencing auditory visual (AV) hallucinations and parasomnia?
What is the next step in managing a patient with hypotension, tachycardia, and recent initiation of fluoxetine (selective serotonin reuptake inhibitor) for generalized anxiety disorder, who is also on nifedipine (calcium channel blocker) and hydrochlorothiazide (diuretic) for hypertension?
What is the appropriate workup for an 87-year-old male with dementia and epilepsy, on quetiapine, lamotrigine, trazodone, and citalopram, presenting with upper extremity bruising secondary to self-gripping?
What is the first-line sleeping tablet for an 85-year-old patient?
What does a homocysteine level indicate?
What is the cause of non-pitting, doughy subcutaneous nodules in the pretibial areas of a patient with known Graves' disease (Hyperthyroidism)?
What symptoms can a 61-year-old postmenopausal woman expect after a total hysterectomy with bilateral oophorectomy (removal of both ovaries)?
What is the immediate management protocol for a patient presenting with symptoms of a stroke?
What strategies can be used to mitigate late toxicity in head and neck cancer patients requiring re-irradiation within 6 months, considering Organs At Risk (OAR) constraints?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question