Can Quetiapine (Seroquel) cause urinary retention?

Can Quetiapine (Seroquel) Cause Urinary Retention?

Yes, quetiapine can cause urinary retention through its anticholinergic (antimuscarinic) effects, and the FDA drug label specifically warns that it should be used with caution in patients with urinary retention risk factors. 1

Mechanism of Action

Quetiapine causes urinary retention through its active metabolite norquetiapine, which has moderate to strong affinity for several muscarinic receptor subtypes. 1 This anticholinergic activity directly impairs detrusor contractility and bladder function, similar to other antipsychotic medications. 2, 3

Clinical Evidence and Incidence

The risk is well-established but the exact incidence is not precisely quantified in the literature. Observational studies suggest that up to 10% of urinary retention episodes may be attributable to concomitant medication use, with antipsychotic drugs being a recognized contributor. 3 A systematic review found that antipsychotics as a class are associated with urinary retention, though specific incidence rates vary by agent. 4

High-Risk Populations

Elderly patients face substantially elevated risk due to:

• Pre-existing benign prostatic hyperplasia (particularly in males) 1, 5
• Concurrent use of other anticholinergic medications 1, 3
• Age-related bladder dysfunction 6, 3

The FDA label explicitly states quetiapine should be used with caution in patients with current or prior history of urinary retention, clinically significant prostatic hypertrophy, or constipation. 1

Clinical Presentation and Monitoring

Urinary retention from quetiapine can manifest as:

• Bladder distension with lower abdominal discomfort 7
• Difficulty initiating urination or incomplete bladder emptying 3
• In severe cases, complete inability to void requiring catheterization 4

Before initiating quetiapine, assess for symptoms of obstructive urinary flow, especially in elderly patients. 6, 7 Consider baseline urological evaluation in patients with pre-existing urinary problems. 8, 7

Management Approach

When urinary retention occurs:

1. Immediate intervention: Urinary catheterization if acute retention is present 3

2. Medication adjustment: Discontinue quetiapine or reduce to the lowest effective dose 8, 7, 4 The majority of case reports demonstrate improvement in urinary retention upon discontinuation or dose reduction. 4

3. Alternative agents: Consider switching to antipsychotics with lower anticholinergic burden if continued antipsychotic therapy is necessary 3

Drug Interactions and Compounding Risk

Avoid combining quetiapine with other anticholinergic medications whenever possible, as this substantially increases urinary retention risk. 1 The anticholinergic effects are additive when quetiapine is used with:

• Anticholinergic respiratory agents 3
• Tricyclic antidepressants 6, 3
• Antimuscarinics for overactive bladder 2
• Other antipsychotics with anticholinergic properties 6, 3

Prevention Strategies

Use the lowest effective dose of quetiapine in at-risk patients (elderly, males with prostatic hypertrophy, those with prior urinary difficulties). 8, 7 Consider alpha-adrenergic blockers like tamsulosin prophylactically in high-risk patients, as this has shown benefit in reducing opioid-related urinary retention and may have similar utility here. 6

Important Clinical Caveat

Moderate bladder distension (approximately 300 mL) can trigger sympathetic nervous system stimulation and cause substantial blood pressure elevation. 8 This is particularly relevant in patients on quetiapine who may already have cardiovascular risk factors, making prompt recognition and treatment of urinary retention essential.