Medications That Cause Retrograde Ejaculation
Alpha-blockers used for benign prostatic hyperplasia are the most common medications causing retrograde ejaculation, with tamsulosin showing dose-dependent risk (8.4% at 0.4 mg and 18.1% at 0.8 mg), while antipsychotic medications including quetiapine, risperidone, thioridazine, iloperidone, and clozapine also cause this adverse effect. 1, 2, 3
Alpha-Blockers (Primary Culprits)
Tamsulosin is the most extensively documented alpha-blocker causing retrograde ejaculation:
- At 0.4 mg daily: 8.4% incidence of abnormal ejaculation (including retrograde ejaculation) 1
- At 0.8 mg daily: 18.1% incidence of abnormal ejaculation 1
- The FDA label explicitly lists "ejaculation failure, ejaculation disorder, retrograde ejaculation, and ejaculation decrease" as dose-related adverse effects 1
- 1.6% of patients discontinued 0.8 mg tamsulosin specifically due to abnormal ejaculation 1
Other alpha-blockers that cause retrograde ejaculation include:
- Alfuzosin 4
- Terazosin 4
- All alpha-blockers approved for lower urinary tract symptoms carry this risk, though they differ in likelihood 3
Antipsychotic Medications
The following antipsychotics are documented to cause retrograde ejaculation:
- Quetiapine - despite being considered to have fewer sexual side effects than other antipsychotics 2
- Risperidone 2
- Thioridazine 2
- Iloperidone 2
- Clozapine 2
Mechanism and Clinical Context
Alpha-blockers cause retrograde ejaculation through adrenergic blockade of the bladder neck, preventing its closure during ejaculation 4. This is the same mechanism that makes these drugs useful for treating premature ejaculation when ejaculatory delay is desired 4.
Antipsychotic-induced retrograde ejaculation likely occurs through alpha-adrenergic antagonism, though the exact mechanism varies by agent 2.
Important Clinical Pitfall
Do not confuse medications that TREAT retrograde ejaculation with those that CAUSE it:
- Imipramine (tricyclic antidepressant) is used to treat retrograde ejaculation at 25-75 mg daily 5, 6, 2
- Pseudoephedrine (alpha agonist) is used to treat retrograde ejaculation at 60 mg every 6 hours 7
- These agents work by increasing sympathetic tone at the bladder neck, opposite to the mechanism of alpha-blockers 5, 6, 7
Additional Context from Diabetes Guidelines
Diabetic autonomic neuropathy itself causes retrograde ejaculation independent of medications, so diabetic patients on alpha-blockers face compounded risk 4. This is relevant when evaluating whether medication or underlying disease is the primary cause 4.