Risk for prolonged erection may warrant new black box warning for quetiapine, researchers say
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Quetiapine may need a new black box warning because of its association with prolonged and sometimes painful erections known as priapism, according to data presented at the American Society of Clinical Psychopharmacology Annual Meeting.
“Quetiapine-induced priapism is considered a rare occurrence and it is not seriously taken into consideration by physicians before prescribing,” Simona L. Morosan, MD, of Iuliu Haieganu University of Medicine and Pharmacy in Romania, told Healio Psychiatry. “If our hypothesis of increased genetic risk associated with being African or African American is correct, clinicians might ask about a possible history of priapism or quetiapine-induced priapism when treating individuals with this possible genetic risk.”
In a poster presentation, Morosan and coauthor Michael H. Brophy, MD, a psychiatrist with a private practice in Texas, noted that research has reported quetiapine (Seroquel, AstraZeneca), an antidepressant and antipsychotic, as useful in treating anxiety and depression among individuals with substance dependence and substance-induced anxiety disorders who exhibited minimal improvement on selective serotonin reuptake inhibitors or other non-benzodiazepine anxiety medications. Researchers of a 2011 case report found that a Turkish prisoner who “had drug abuse” but no other diagnosed illness experienced priapism after receiving a 200 mg dose of quetiapine. Further, results of a review article suggested that antagonism of alpha 1 adrenergic receptors is linked to the association between antipsychotics and priapism.
Because “quetiapine moiety is midrange in its affinity for the alpha 1 adrenergic receptor but had the highest number of case reports associated with its affinity,” Morosan and Brophy wrote, metabolites of quetiapine, primarily norquetiapine, may contribute to priapism. Increased concentrations of norquetiapine among those of African heritage may put them at increased risk for priapism and warrant a change in the black box warning of quetiapine, the researchers noted.
“Clinicians might consider quetiapine to have an additional risk among these populations, and genetic screening might be useful,” Morosan told Healio Psychiatry.