Can Seroquel (quetiapine) cause paresthesia?

Quetiapine (Seroquel) and Paresthesia

Yes, quetiapine (Seroquel) can cause paresthesia as a documented side effect, particularly at higher doses or in combination therapy.

Evidence for Paresthesia as a Side Effect

• The FDA drug label for quetiapine specifically lists paresthesia as a reported adverse reaction in clinical trials for bipolar depression, affecting approximately 3% of patients taking quetiapine compared to 2% in the placebo group 1.

• In the FDA-approved drug information, paresthesia is listed among the adverse reactions that occurred during therapy of bipolar depression in ≥2% of patients treated with quetiapine 1.

• Paresthesia is also documented as a side effect in combination therapy, particularly when quetiapine is used with phentermine/topiramate, where it is listed as a common side effect 2.

Mechanism and Risk Factors

• While the exact mechanism of quetiapine-induced paresthesia is not fully understood, it may be related to:

  • Quetiapine's antagonistic effects on multiple neurotransmitter receptors, particularly serotonin (5-HT2A) receptors 3.
  • Similar mechanisms to those observed with other atypical antipsychotics like olanzapine, which has been reported to cause paresthesia through dopamine D2 and serotonin 5-HT2A and 5-HT2C receptor antagonism 4.

• Risk factors that may increase the likelihood of experiencing paresthesia with quetiapine include:

  • Higher doses of quetiapine 1.
  • Combination therapy with other medications that affect serotonin pathways 5.
  • Individual sensitivity to neurological side effects 6.

Clinical Considerations

• Paresthesia with quetiapine typically presents as:

  • Tingling sensations 4.
  • Numbness or abnormal sensations in extremities 1.
  • These symptoms may be dose-dependent, with higher incidence at increased doses 1.

• It's important to differentiate quetiapine-induced paresthesia from:

  • Serotonin syndrome, which can occur when quetiapine is combined with other serotonergic agents and presents with more severe symptoms including confusion and muscle spasms 5.
  • Other neurological conditions that may cause similar symptoms.

Management Recommendations

• If paresthesia occurs with quetiapine:

  • Consider dose reduction if symptoms are mild and the therapeutic benefit outweighs the side effect 4.
  • In more severe cases, discontinuation of quetiapine may be necessary, with appropriate tapering to avoid withdrawal symptoms 4.
  • Document the adverse effect in the patient's medical record to inform future medication decisions 1.

• For patients who require continued antipsychotic therapy but experience paresthesia with quetiapine:

  • Consider switching to an alternative antipsychotic with a different side effect profile 3.
  • Monitor closely during medication transitions for both symptom control and side effects 6.

Prevention and Monitoring

• Start with lower doses of quetiapine when initiating therapy and titrate slowly to minimize side effects 1.
• Regularly assess for neurological side effects, including paresthesia, especially during dose adjustments 1.
• Use caution when combining quetiapine with other medications that may increase the risk of neurological side effects 5.