Resolution of Retrograde Ejaculation with Three-monthly Paliperidone Palmitate: A Case Report

Sexual dysfunction is not uncommonly seen among patients being treated with antipsychotics. Retrograde ejaculation has been reported with the atypical antipsychotic paliperidone palmitate and it related to antagonism of the alpha-1 receptor. The author presents a case of a 27-year-old man who was admitted due to a manic relapse of his bipolar disorder. At the time, he was on quetiapine 400 mg bd. Upon stabilization, a decision was made to augment his treatment with intramuscular paliperidone palmitate for long term relapse prevention. Nine months later, his manic symptoms were under control, but he developed retrograde ejaculation. A urology consult determined that the causative agent was the monthly paliperidone palmitate and a decision was made to switch him to the three-monthly paliperidone palmitate. After two doses of the new formulation, he was able to resume having anterograde ejaculation. It is postulated that the longer time to achieve peak concentration and slower release of the three-monthly formulation are the possible reasons for the resolution of the patient’s retrograde ejaculation. Switching from monthly to three-monthly formulation of paliperidone palmitate may help alleviate retrograde ejaculation in patients who are already showing remission of their illness with monthly paliperidone palmitate.  Please click PDF below to download the full paper...