Case report: Severe and treatment-resistant spontaneous ejaculation secondary to atomoxetine

Probable Genitourinary Adverse Events Associated With Atomoxetine in an Adult Male: A Case Report

“…2 Several case reports align with the findings of this pooled analysis, which are described in Table 1. [3][4][5][6][7][8] One case describes urinary hesitancy following atomoxetine initiation with quick resolution of symptoms upon discontinuation of the medication in a 41-yearold man also taking fluoxetine, a CYP 2D6 inhibitor. 3 Three cases describe urinary retention in children and adolescents.…”

“…[3][4][5][6] Two additional case reports document onset of spontaneous ejaculation both with and without orgasmic sensation following atomoxetine initiation in young males not taking other medications. 7,8 Atomoxetine increases norepinephrine by inhibiting its reuptake, leading to an increased sympathetic response, potentially describing the mechanism of urinary hesitancy or retention. [3][4][5] Urinary hesitancy can be described in part by a regulatory dysfunction of the sympathetic and parasympathetic pathways controlling the bladder and related muscles involved with micturition.…”

“…Data from clinical trials and case reports suggests this is a common symptomatic timeline and that risks for genitourinary adverse events are higher for males compared to females. [2][3][4][5][6][7][8] Limitations to our report are that the milky, white-colored discharge was not analyzed and confirmed to be semen, and that we did not specifically ask the patient if discharge was associated with an orgasmic sensation, as reported elsewhere. 7 Clinicians should be aware of the possible genitourinary adverse events of atomoxetine and educate patients on this risk.…”

“…[2][3][4][5][6][7][8] Limitations to our report are that the milky, white-colored discharge was not analyzed and confirmed to be semen, and that we did not specifically ask the patient if discharge was associated with an orgasmic sensation, as reported elsewhere. 7 Clinicians should be aware of the possible genitourinary adverse events of atomoxetine and educate patients on this risk. Monitoring for these adverse events should be performed explicitly, as patients may not spontaneously report them.…”