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Elfessi Z, Jhawar A, Martino J. Priapism Associated With the Addition of Hydroxyzine to Risperidone: A Case Report. J Pharm Pract 2024; 37:758-760. [PMID: 37144572 DOI: 10.1177/08971900231175704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Background: Hydroxyzine hydrochloride is a piperazine derivative antihistamine that is used in the treatment of anxiety. Its tendency to cause somnolence makes it an attractive option for patients with anxiety-induced insomnia. Despite its antihistamine activity, hydroxyzine is noted to have alpha-adrenergic antagonism activity. Other alpha-adrenergic inhibitors have been implicated in medication-induced priapism, including risperidone. Risperidone is a second-generation antipsychotic that primarily blocks serotonin and dopamine receptors, while also inhibiting alpha-1 and alpha-2 receptors with high affinity. Objective: We report a case of a first-of-its-kind case report of a patient who was stable on risperidone and presented with priapism after taking hydroxyzine nightly for the previous 10 days. Results: A 35-year-old male with a past psychiatric history of depression, generalized anxiety disorder, schizoaffective disorder, presented to the emergency department with priapism for 15 hours that required intracaveronsal phenylephrine hydrochloride and manual drainage to achieve detumescence. The patient was on a stable dose risperidone but reported taking hydroxyzine 50 mg nightly for anxiety and insomnia 10 days prior to emergency department admission. Upon resolution of the priapism, the patient stopped hydroxyzine, but continued risperidone. The patient had another prolonged erection 10 days after stopping hydroxyzine; however, he reported that it resolved spontaneously without intervention after 4 hours. Conclusion: This case report demonstrates the risk of addition of hydroxyzine to antipsychotics which can result in an increased risk of priapism or prolonged episodes.
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Affiliation(s)
- Zane Elfessi
- College of Pharmacy - Department of Pharmacy Practice, University of Illinois-Chicago, Chicago, IL, USA
- Department of Pharmacy, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Archana Jhawar
- College of Pharmacy - Department of Pharmacy Practice, University of Illinois-Chicago, Chicago, IL, USA
- Department of Pharmacy, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Julie Martino
- Department of Emergency Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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2
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Misawa F, Takeuchi H. Priapism and Second-Generation Antipsychotics: Disproportionality Analysis of a Spontaneous Reporting System Database in Japan. Psychiatry Clin Neurosci 2022; 76:525-526. [PMID: 35779005 DOI: 10.1111/pcn.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/18/2022] [Accepted: 06/25/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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3
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A Case of Priapism in a Child With Autism Spectrum Disorder, Possibly Due to Risperidone Treatment With Addition of Atomoxetine. Clin Neuropharmacol 2022; 45:177-178. [PMID: 36093917 DOI: 10.1097/wnf.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Risperidone is an effective drug used for the treatment of irritability in children with autism spectrum disorder (ASD). Atomoxetine (ATX) is a well-tolerated drug used in first-line therapy in children with attention-deficit/hyperactivity disorder (ADHD). However, uncommon adverse effects of risperidone and ATX are a concern among mental health professionals. To our knowledge, this is the first case report of priapism after addition of ATX upon existing treatment with risperidone. METHODS Written informed consent for publication was obtained from the patient and his parents, and their identities were concealed for ethical reasons. RESULTS Here, we report a case of priapism as an adverse effect of ATX and risperidone treatment in a 7-year-old boy with ASD and comorbid ADHD. In this case, priapism was not observed with risperidone until ATX was added. CONCLUSIONS Priapism is a condition viewed as a medical emergency. Although risperidone-induced priapism is a rare phenomenon, it is advised for clinicians to consider the drug interactions in treatment of ASD and ADHD in terms of early diagnosis and intervention.
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Jannini TB, Sansone A, Rossi R, Di Lorenzo G, Toscano M, Siracusano A, Jannini EA. Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment. Expert Opin Pharmacother 2022; 23:1065-1080. [PMID: 35470768 DOI: 10.1080/14656566.2022.2071124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION : First- and second-generation antipsychotics are highly accountable for causing a plethora of medical side effects, ranging from metabolic imbalances to sexual dysfunction (SD), that frequently undermine patient-doctor relationships. Nevertheless, to date antipsychotics are one of the best treatment options for dealing with numerous either acute or chronic conditions like agitation, suicidality, depression, dementia, and of course psychosis. For these reasons, clinicians need to handle them wisely to preserve patients' sexual health, avoid poor therapeutic adherence and prevent high rates of therapy drop-out. AREAS COVERED : This article reviews the literature on pharmacologic approaches for management strategies in men who are administered with antipsychotics and developed SD. The etiology of antipsychotic-induced SD is also discussed. EXPERT OPINION : Clinicians must consider sexual life as a major health domain. To do so, a first step would be to measure and monitor sexual function by means of psychometric tools. Secondly, primary prevention should be conducted when choosing antipsychotics, i.e., picking sex-sparing compounds like aripiprazole or brexpiprazole. Thirdly, if sexolytic compounds cannot be dismissed, such as first-generation antipsychotics, risperidone, paliperidone, or amisulpride, then aripiprazole 5-20 mg/day adjunctive therapy has proven to be most effective in normalizing prolactin levels and consequently treating antipsychotic-induced SD.
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Affiliation(s)
- Tommaso B Jannini
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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5
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Grover S, Sarkar S, Avasthi A. Management of Systemic Medical Emergencies Associated with Psychotropic Medications. Indian J Psychiatry 2022; 64:S252-S280. [PMID: 35602374 PMCID: PMC9122155 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1014_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Ajit Avasthi
- Consultant Psychiatrist, Fortis Hospital, Mohali and Chhuttani Medical Centre, Chandigarh, India
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6
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Ateb S, Fourati T, Ben Rejeb H, Januel D, Bouaziz N. Risperidone-induced priapism: a case report and literature review. Ther Adv Psychopharmacol 2022; 12:20451253221113246. [PMID: 36051502 PMCID: PMC9424871 DOI: 10.1177/20451253221113246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/26/2022] [Indexed: 11/15/2022] Open
Abstract
Priapism is a rare pathological condition defined as painful and persistent penile erection that is unrelated to sexual stimulation. It can be classified as ischaemic or non-ischaemic. Many causes have been attributed to ischaemic priapism, including the use of some medications such as antipsychotics. The mechanism of priapism associated with antipsychotics is thought to be related to alpha-adrenergic blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis. In this paper, we describe a case of a patient who suffered from Risperidone-induced priapism, and how this adverse effect was resolved by switching to olanzapine followed by olanzapine pamoate. A literature search on PubMed/Medline up to 2011 was conducted by some doctors from London and found 30 cases of priapism associated with risperidone. Based on this work, we searched PubMed through 2021, using the keywords 'priapism' and 'risperidone' and found a total of 43 cases of priapism involving risperidone. Priapism is not correlated with the dosage of this psychotropic drug, and has also occasionally occurred when risperidone has been used in conjunction with another drug. The question of choosing a replacement antipsychotic after the first one has induced priapism, remains problematic. It would be preferable to switch to a drug with less marked alpha1-blocking properties, but no consensus has been reached as to the best choice of medication. Finally, any prescription of an antipsychotic treatment must be preceded by a careful interrogation in search of risk factors for priapism, and the patient should be made aware of the possible occurrence of this side effect and the need to then seek urgent medical advice.
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Affiliation(s)
- Sarra Ateb
- Établissement Public de Santé de Ville-Evrard (Pôle 93G03), 5 Rue Du Docteur Delafontaine 93200 Saint-Denis, France
| | - Taoufik Fourati
- Établissement Public de Santé de Ville-Evrard (Pôle 93G03), Saint-Denis, France
| | - Hammadi Ben Rejeb
- Établissement Public de Santé de Ville-Evrard (Pôle 93G03), Saint-Denis, France
| | - Dominique Januel
- Établissement Public de Santé de Ville-Evrard (Pôle 93G03), Saint-Denis, France
| | - Noomane Bouaziz
- Établissement Public de Santé de Ville-Evrard (Pôle 93G03), Saint-Denis, France
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Cuomo A, Bianchetti A, Cagnin A, De Berardis D, Di Fazio I, Antonelli Incalzi R, Marra C, Neviani F, Nicoletti F. Trazodone: a multifunctional antidepressant. Evaluation of its properties and real-world use. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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8
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El Jabiry SE, Mansour A, Barrimi M, Oneib B, El Ghazouani F. A very rare case of priapism under aripiprazole in a patient followed for bipolar disorder: A CARE-compliant report. Ann Med Surg (Lond) 2021; 62:216-218. [PMID: 33537133 PMCID: PMC7843361 DOI: 10.1016/j.amsu.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/09/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Priapism is a urological emergency characterized by abnormally prolonged, painful and irreducible erection. It occurs without a sexual stimulation and habitually exceeds 6 h. About a half of iatrogenic priapisms are believed to be associated with antipsychotics. Until to date, very few cases of aripiprazole-associated priapism were reported. CASE PRESENTATION In this case report, we present the clinical findings of a 40-year-old patient that developed priapism after treatment with aripiprazole after his hospitalization for an episode of clinical mania following treatment discontinuation for bipolar I disorder. The management was successful and priapism was resolved spontaneously. CLINICAL DISCUSSION Despite its low affinity to alpha-1 adrenergic receptors, aripiprazole may be associated with priapism. Several potential factors involved in the pathogenesis of this adverse event have been reported in the literature including history of priapism in a different class of neuroleptics and consumption of psychoactive drugs which are the principal factors found in our case. CONCLUSION Priapism may occur even during treatment with antipsychotics that have a low affinity to alpha1-adrenergic receptors. All patients on antipsychotics should be informed about the risk of this rare but serious adverse event.
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Affiliation(s)
- Salah-Eddine El Jabiry
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Atif Mansour
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Mohammed Barrimi
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Bouchra Oneib
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Fatima El Ghazouani
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
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9
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Montejo AL, de Alarcón R, Prieto N, Acosta JM, Buch B, Montejo L. Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach. J Clin Med 2021; 10:jcm10020308. [PMID: 33467621 PMCID: PMC7829881 DOI: 10.3390/jcm10020308] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022] Open
Abstract
Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients' tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results.
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Affiliation(s)
- Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain;
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (J.M.A.); (B.B.)
- Nursing School, University of Salamanca, Av. Donates de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Rubén de Alarcón
- Psychiatry Service, Infanta Elena Hospital, Juan Ramon Jiménez Hospital, Ronda Exterior Norte S/N, 21080 Huelva, Spain;
| | - Nieves Prieto
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain;
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (J.M.A.); (B.B.)
| | - José Mª Acosta
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (J.M.A.); (B.B.)
| | - Bárbara Buch
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (J.M.A.); (B.B.)
| | - Laura Montejo
- Barcelona Bipolar and Depressive Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clinic of Barcelona, 08401 Catalonia, Spain;
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10
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Shah T, Deolanker J, Luu T, Sadeghi-Nejad H. Pretreatment screening and counseling on prolonged erections for patients prescribed trazodone. Investig Clin Urol 2020; 62:85-89. [PMID: 33314808 PMCID: PMC7801163 DOI: 10.4111/icu.20200195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/22/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged erections and priapism, prior to trazodone treatment. Materials and Methods We identified patients under the age of 50 on trazodone as of February 27, 2019 at the VA New Jersey Health Care System. Patients were asked about information provided to them prior to medication initiation, occurrence of prolonged erections/priapism, and reporting rate of side effects. Results Two hundred and twenty nine out of five hundred and twenty four male patients agreed to participate in the study. Forty three out of two hundred and twenty nine of patients were informed about the side effects of prolonged erections and 37/229 of patients were informed of risk of priapism prior to treatment. Only 17/229 of patients were asked if they had had any episodes of prolonged erection or priapism in the past. Eighteen patients developed prolonged erection while taking trazodone. Only 5/18 patients who had developed prolonged erections informed their physicians. Conclusions Only a fraction of patients were properly screened for previous prolonged erections or priapism and properly informed about the side effects of trazodone. Urologist should better educate trazodone prescribers, such as family medicine and psychiatric colleagues, regarding the side effects of trazodone. It is imperative that prescribing physicians appropriately screen and educate patients prior to trazodone initiation and instruct patients to report any treatment side effects to avoid potential long-term adverse outcomes.
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Affiliation(s)
- Tejash Shah
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA.
| | - Juhi Deolanker
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA
| | - Thaiphi Luu
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA
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Hwang T, Shah T, Sadeghi-Nejad H. A Review of Antipsychotics and Priapism. Sex Med Rev 2020; 9:464-471. [PMID: 33214060 DOI: 10.1016/j.sxmr.2020.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pharmacologically induced priapism is now the most common cause of priapism, with approximately 50% of drug-related priapism being attributed to antipsychotic usage. The majority of pharmacologic priapism is believed to result in ischemic priapism (low flow), which may lead to irreversible complications, such as erectile dysfunction. It is imperative that prescribing physicians be aware of potentially inciting medications. OBJECTIVES To identify medications, specifically antipsychotics, associated with priapism and prolonged erections and understand the rates and treatment of these side effects. METHODS A PubMed search of all articles available on the database relating to priapism, prolonged erections, and antipsychotics was performed. RESULTS Various typical and atypical antipsychotic drugs (APDs) have been implicated in pharmacologically induced priapism. In addition to dopaminergic and serotoninergic receptors, APDs have affinities for a wide array of other receptors in the central nervous system, including histaminergic, noradrenergic, and cholinergic receptors. Although the exact mechanism is unknown, the most commonly proposed mechanism of priapism associated with APDs is α-adrenergic blockade in the corpora cavernosa of the penis. Priapism appears in only a small fraction of men using medications with α1-receptor-blocking properties, indicating differential sensitivities to the α-blocking effect among men, and/or additional risk factors that may contribute to the development of priapism. The best predictor for the subsequent development of priapism is a past history of having prolonged and painless erections. The acute management algorithm of APD-induced priapism is the same as for other causes of low-flow priapism. CONCLUSION Clinicians should educate patients treated with antipsychotics about the potential for priapism and its sequelae including permanent erectile dysfunction. Appropriate patient education will raise awareness, encourage early reporting, and help reduce the long-term consequences associated with priapism through early intervention. Hwang T, Shah T,Sadeghi-NejadH. A Review of Antipsychotics and Priapism. Sex Med Rev 2021;9:464-471.
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Affiliation(s)
- Thomas Hwang
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tejash Shah
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Greiner T, Schneider M, Regente J, Toto S, Bleich S, Grohmann R, Heinze M. Priapism induced by various psychotropics: A case series. World J Biol Psychiatry 2019; 20:505-512. [PMID: 30208753 DOI: 10.1080/15622975.2018.1520396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Priapism is a rare adverse effect of several psychotropics. Both, typical and atypical antipsychotics, as well as trazodone are known to cause priapism. The mechanism is still not fully understood, however, the most common assumption is that priapism occurs due to the α-adrenergic blocking effects of the drugs. Methods: Here we present from the AMSP database 19 cases of priapism being likely caused by a variety of psychotropics. We further reviewed case reports in order to find similarities and to identify risk factors. Results: Several patterns emerged: common was the introduction of a specific drug to a patient resulting into the immediate development of priapism, as well as a change in drug plasma concentration due to a change of drug dosage or due to comedication with certain SSRIs. Conclusion: However, priapism can occur at nearly any age and with any dose. Clinicians must be aware of the risk and reports of early signs, such as prolonged erections, should be taken seriously.
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Affiliation(s)
- Timo Greiner
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
| | - Michael Schneider
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
| | - Johannes Regente
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians University , Munich , Germany
| | - Martin Heinze
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
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13
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Polypharmacy Leading to Priapism in HIV Patient with Schizoaffective Disorder: A CYP450 Cascade. Case Rep Psychiatry 2019; 2019:4562065. [PMID: 30719367 PMCID: PMC6335676 DOI: 10.1155/2019/4562065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/27/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022] Open
Abstract
With increasing trend of polypharmacy, there are higher chances of drug-drug interactions leading to adverse effects, especially in psychiatric patients with co-morbid chronic medical problems. This case demonstrates a schizoaffective 30-year-old male on highly active antiretroviral therapy (HAART) who reported an incident of priapism potentially caused by an interaction between previously prescribed atypical antipsychotic, trazodone, norepinephrine dopamine reuptake inhibitor (NDRI), HAART, and newly added selective serotonin reuptake inhibitor (SSRI). This case emphasizes obtaining careful medication history, understanding cytochrome P450 (CYP450) enzyme and its subtypes, and discouraging polypharmacy. Clinicians must educate their patients about different sexual side effects as these can be socially stigmatizing and can further deteriorate mental health symptoms.
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Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2018; 7:283-292. [PMID: 30503727 DOI: 10.1016/j.sxmr.2018.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Priapism has been linked to many commonly prescribed medications, as well as recreational drugs and toxins. Although the incidence of priapism as a result of medication is small, the increasing use of antidepressants, antipsychotics, and recreational drugs may lead to more cases of pharmacologically-induced priapism in the future. AIM To provide a comprehensive, up-to-date review of the most common causes of pharmacologically induced priapism and discuss incidence, pathophysiology, and basic management strategies. METHODS A review of the available literature from 1960 to 2018 was performed using PubMed with regards to pharmacologically induced priapism. MAIN OUTCOME MEASURE We reviewed publications that outlined incidence, pathophysiology, and management strategies for various pharmacologic causes of priapism: antidepressants, antipsychotics, antihypertensives, methylphenidate, cocaine, heparin, gonadotropin-releasing hormone, propofol, spider bites, and other miscellaneous causes. RESULTS An understanding of the pathophysiology behind common pharmacologic causes of priapism can assist in the development of better treatment strategies and prevent future episodes of priapism. By understanding the potential risks associated with the use of medications with α-blocking or sympathomimetic properties, physicians can reduce the likelihood of priapism in their patients, especially those with other medical conditions that put them at increased baseline risk. Early corporal aspiration and injection of phenylephrine reduces additional complications related to priapism. In select patients, early placement of a penile prosthesis may prevent further morbidity. CONCLUSION By developing a greater understanding of common pharmacologic causes of priapism, physicians can promptly identify and manage symptoms, leading to decreased patient morbidity. Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2019;7:283-292.
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Affiliation(s)
| | - Amit G Reddy
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Tan V Le
- Department of Urology, Tulane University, New Orleans, LA, USA; Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
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15
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Bejrananda T, Thongseiratch T. Frequent Penile Erection in a Boy With Autism-spectrum Disorder: Case Report. Urology 2018; 118:195-197. [DOI: 10.1016/j.urology.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
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El Zahran T, Morgan BW, Hon S, Herrington L, Geller RJ. Unintentional trazodone overdoses in children ≤6 years of age: data from poison center over a period of 16 years. Clin Toxicol (Phila) 2018; 57:56-59. [PMID: 29929405 DOI: 10.1080/15563650.2018.1485928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50-500 mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age. METHODS Cases with acute trazodone ingestions in children ≤6 years of age between 2000 and 2015 were retrospectively reviewed. Data were analyzed for dose (mg/kg), clinical effects, management site, treatment, and outcome. Cases with coingestions, unknown outcome, or unknown dose were excluded. RESULTS A total of 84 patients (mean age 26.7 months, 35 females, 49 males) were included. Of those, 52 (61.9%) had no clinical effects; 29 (34.5%) had minor effects (vomiting, dizziness, headache); and three (3.6%) had moderate effects (ataxia, slurred speech, priapism). No major effects or deaths were observed. Moderate effects were manifested at doses ≥6.9 mg/kg. Priapism occurred in a 2-year-old child at a dose of 6.9 mg/kg. Sixteen (19%) patients were managed at home and 68 (81%) patients were referred to a HCF. Among those referred to a HCF, three (4.4%) patients had moderate effects with ingested dose ≥6.9 mg/kg. However, 27 (39.7%) patients of those referred to a HCF had an ingested dose <6 mg/kg and none of them manifested symptoms beyond minor effects. All referred patients had uneventful recovery and no sequela. CONCLUSIONS Children should be referred for further evaluation in acute unintentional trazodone ingestions with doses ≥6 mg/kg.
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Affiliation(s)
- Tharwat El Zahran
- a Department of Emergency Medicine , Emory University School of Medicine , Atlanta , GA , USA.,b Georgia Poison Center , Atlanta , GA , USA
| | - Brent W Morgan
- a Department of Emergency Medicine , Emory University School of Medicine , Atlanta , GA , USA.,b Georgia Poison Center , Atlanta , GA , USA
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Quint R, Lillo-Le Louet A, Pouchot J, Arlet JB. Priapism in sickle cell disease: Beware of neuroleptics. Am J Hematol 2018; 93. [PMID: 29885077 DOI: 10.1002/ajh.25156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Raphaëlle Quint
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Agnès Lillo-Le Louet
- Pharmacovigilance center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Jacques Pouchot
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Jean-Benoît Arlet
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
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Vreugdenhil S, Weidenaar AC, de Jong IJ, van Driel MF. Sleep-Related Painful Erections: A Meta-Analysis on the Pathophysiology and Risks and Benefits of Medical Treatments. J Sex Med 2018; 15:5-19. [DOI: 10.1016/j.jsxm.2017.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 12/12/2022]
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Priapism associated with the addition of risperidone to methylphenidate monotherapy: a case report. North Clin Istanb 2017; 4:85-88. [PMID: 28752150 PMCID: PMC5530165 DOI: 10.14744/nci.2015.82574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/02/2015] [Indexed: 11/20/2022] Open
Abstract
Priapism is a state of prolonged and unwanted erection without sexual stimulation or desire. Priapism may occur with a variety of diseases or as a side effect of medication. Immediate diagnosis and treatment is essential, as ischemia of cavernous tissues results in erectile dysfunction. Described in the present report is a 12-year-old male with priapism associated with the addition of risperidone to methylphenidate monotherapy. Priapism decreased and disappeared following discontinuation of drug therapy and implementation of cavernous drainage. To our knowledge, the present is the first report to describe priapism associated with the addition of risperidone to methylphenidate monotherapy. It is hoped that attention will be drawn to the risk of priapism caused by the combination of these psychopharmacologic agents.
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Abstract
Psychiatric medications are used commonly in hospitalized patients and are particularly indicated in patients who are critically ill to manage many conditions. Due to their many indications in the intensive care unit (ICU), psychiatric medications should be closely monitored in these medically compromised patients for adverse reactions and medical complications because they may affect essentially all organ systems. These range from life-threatening reactions to other less significant effects, such as sedation, to other detrimental complications, such as pancreatitis. Knowledge of psychopharmacology as well as the diagnosis and treatment of these complications is imperative in treating patients in the ICU.
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Affiliation(s)
- Sheila C Lahijani
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA.
| | - Kirk A Harris
- Department of Psychiatry, Rush University, 1725 West Harrison Street, Suite 955, Chicago, IL 60612, USA
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22
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Griffith KM, Eichel EA, Brahm NC. Genital Somatic Complaints in a Woman with Schizoaffective Disorder. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20161221-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Hani Raoul Khouzam
- Employee Behavioral Health Dartmouth, Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Behavioral Health Bureau, Monterey County Department of Health, Salinas, CA, USA
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Greenway FL, Shanahan W, Fain R, Ma T, Rubino D. Safety and tolerability review of lorcaserin in clinical trials. Clin Obes 2016; 6:285-95. [PMID: 27627785 DOI: 10.1111/cob.12159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/03/2016] [Accepted: 07/04/2016] [Indexed: 12/13/2022]
Abstract
Lorcaserin is a novel selective serotonin 2C receptor agonist indicated by the US Food and Drug Administration for chronic weight management in adults with obesity or overweight with ≥1 comorbidity. The safety and efficacy of lorcaserin were established during two Phase III clinical trials in patients without diabetes (BLOOM and BLOSSOM) and one Phase III clinical trial in patients with type 2 diabetes (BLOOM-DM). Headache was the most common adverse event experienced by patients during all Phase III trials. Additional adverse events occurring in >5% of patients receiving lorcaserin included dizziness, fatigue, nausea, dry mouth and constipation in patients without diabetes, and hypoglycaemia, back pain, cough and fatigue in patients with diabetes. In a pooled analysis of echocardiographic data collected during the three lorcaserin Phase III trials, the incidence of FDA-defined valvulopathy was similar in patients taking lorcaserin and the placebo. Here, the safety profile of lorcaserin at the FDA-approved dose of 10 mg twice daily is reviewed using data from the lorcaserin Phase III programme, with a focus on theoretical adverse events commonly associated with agonists of the serotonin receptor family. Based on the lorcaserin Phase III clinical trial data, lorcaserin is safe and well tolerated in the indicated patient populations.
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Affiliation(s)
- F L Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
| | - W Shanahan
- Formerly of Arena Pharmaceuticals, Inc., San Diego, CA, USA
| | - R Fain
- Formerly of Eisai Inc., Woodcliff Lake, NJ, USA
| | - T Ma
- Formerly of Eisai Inc., Woodcliff Lake, NJ, USA
| | - D Rubino
- Washington Center for Weight Management and Research, Arlington, VA, USA
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Sui W, Onyeji IC, James MB, Stahl PJ, RoyChoudhury A, Anderson CB. Risk Factors for Priapism Readmission. J Sex Med 2016; 13:1555-61. [PMID: 27496074 DOI: 10.1016/j.jsxm.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Priapism is a urologic emergency with a tendency to recur in some patients. The frequency of, time to, and risk factors for priapism recurrence have not been well characterized. AIM To identify predictors of priapism readmission. METHODS We used the New York Statewide Planning and Research Cooperative System database to identify patients presenting to emergency departments with priapism from 2005 through 2014. Patients were tracked up to 12 months after initial presentation. Proportional hazards regression was used to identify risk factors for priapism readmission. MAIN OUTCOME MEASURES Readmissions for priapism. RESULTS The analytic cohort included 3,372 men with a diagnosis of priapism. The average age at first presentation was 39 ± 18 years and 40% were black. Within 1 year, 24% of patients were readmitted for recurrent priapism, 68% of whom were readmitted within 60 days. On multivariate analysis, sickle cell disease (hazard ratio [HR] = 2.5, 95% CI = 2.0-3.0), drug abuse or psychiatric disease (HR = 1.9, 95% CI = 1.6-2.2), erectile dysfunction history (HR = 1.9, 95% CI = 1.5-2.3), other than commercial medical insurance (HR = 1.2, 95% CI = 1.0-1.4), and inpatient admission for initial priapism event (HR = 0.5, 95% CI = 0.4-0.6) were significant risk factors for readmission. CONCLUSION Nearly one fourth of patients with priapism were readmitted for recurrent priapism within 1 year of initial presentation. Most readmissions were within 60 days. Future research should focus on strategies to decrease recurrences in high-risk patients.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Maxwell B James
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Stevens JR, Rodgers JJ, Stern TA. Idiosyncratic Adverse Reactions to Psychotropic Medications. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160622-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sinha P, Garg A. Use of amisulpride in treating adolescent onset schizophrenia associated with stuttering priapism induced by multiple antipsychotics. Asian J Psychiatr 2016; 19:85-6. [PMID: 26957345 DOI: 10.1016/j.ajp.2015.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Pallavi Sinha
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India.
| | - Amit Garg
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India
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Bhat IA, Shannon KD, Ara A, Coe I. Ninety-six hours ordeal of priapism induced by paroxetine--A case report and literature review. Int J Psychiatry Med 2016; 50:326-34. [PMID: 26443710 DOI: 10.1177/0091217415610312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Priapism is a rare but severe medical condition of sustained and painful erection of penis in the absence of any sexual stimulation, in which the penis does not return to a flaccid state. It is considered to be a medical emergency because without treatment it can lead to permanent damage and fibrosis of penis and in the long run to impotency. Albeit that there is no uniform consensus regarding the duration of sustained erection, an erection lasting more than 4 h is generally considered as an emergency which needs immediate medical attention and care. Priapism is commonly associated with iatrogenic, pharmacologic, underlying medical, or traumatic causes. In this report, we present the case of a 42-year-old African American man who developed priapism after three weeks of therapy with paroxetine which lasted for more than 96 h before coming to the attention of his health-care providers. This case is unique in that there are no reports in literature of an erection lasting for such a long duration following therapy with paroxetine. The objective of this report is to highlight the importance of recognizing the possibility of priapism with selective serotonin reuptake inhibitors in general and paroxetine in particular since this condition is not commonly seen in clinical practice to be associated with selective serotonin reuptake inhibitors and may go unrecognized. Also, potential biological mechanisms involved in the development of paroxetine-induced priapism are presented.
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Affiliation(s)
- Ishrat A Bhat
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, GA, USA
| | - Kelly D Shannon
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, GA, USA
| | - Anjum Ara
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, GA, USA
| | - Ian Coe
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, GA, USA
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Delayed-onset of psychopharmacologically induced priapism: A cautionary case report. Asian J Psychiatr 2015; 17:106. [PMID: 26188724 DOI: 10.1016/j.ajp.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/10/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
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Abstract
Priapism is an adverse effect of medications used to treat psychiatric disorders. Often, this condition is self-limiting but may require urologic intervention involving aspiration and injection to induce detumescence. A case of a 15-year-old patient with priapism secondary to a long-acting stimulant is presented to describe the effectiveness of ketamine treatment for priapism.
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de Boer MK, Castelein S, Wiersma D, Schoevers RA, Knegtering H. The facts about sexual (Dys)function in schizophrenia: an overview of clinically relevant findings. Schizophr Bull 2015; 41:674-86. [PMID: 25721311 PMCID: PMC4393701 DOI: 10.1093/schbul/sbv001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A limited number of studies have evaluated sexual functioning in patients with schizophrenia. Most patients show an interest in sex that differs little from the general population. By contrast, psychiatric symptoms, institutionalization, and psychotropic medication contribute to frequently occurring impairments in sexual functioning. Women with schizophrenia have a better social outcome, longer lasting (sexual) relationships, and more offspring than men with schizophrenia. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships. Although patients consider sexual problems to be highly relevant, patients and clinicians not easily discuss these spontaneously, leading to an underestimation of their prevalence and contributing to decreased adherence to treatment. Studies using structured interviews or questionnaires result in many more patients reporting sexual dysfunctions. Although sexual functioning can be impaired by different factors, the use of antipsychotic medication seems to be an important factor. A comparison of different antipsychotics showed high frequencies of sexual dysfunction for risperidone and classical antipsychotics, and lower frequencies for clozapine, olanzapine, quetiapine, and aripiprazole. Postsynaptic dopamine antagonism, prolactin elevation, and α1-receptor blockade may be the most relevant factors in the pathogenesis of antipsychotic-induced sexual dysfunction. Psychosocial strategies to treat antipsychotic-induced sexual dysfunction include psychoeducation and relationship counseling. Pharmacological strategies include lowering the dose or switching to a prolactin sparing antipsychotic. Also, the addition of a dopamine agonist, aripiprazole, or a phosphodiesterase-5 inhibitor has shown some promising results, but evidence is currently scarce.
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Affiliation(s)
- Marrit K. de Boer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;,*To whom correspondence should be addressed; Department of Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, CC43, 9700 RB Groningen, The Netherlands. tel: +31-50-3616161, fax: +31-50-3611699, e-mail:
| | - Stynke Castelein
- Lentis, Center for Mental Healthcare, Groningen, The Netherlands;,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research center, Groningen, The Netherlands
| | - Durk Wiersma
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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A case of priapism with risperidone. Case Rep Psychiatry 2014; 2014:241573. [PMID: 25379316 PMCID: PMC4213393 DOI: 10.1155/2014/241573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/06/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022] Open
Abstract
Priapism is a urologic emergency defined as a prolonged, possibly painful, penile erection. There are several known causes of priapism including psychotropic medications. One of the mechanisms by which antipsychotics are believed to induce priapism is through alpha-1 antagonism. This is case of a 50-year-old male with a history of schizophrenia with previous priapism related to trazodone, who presents with new onset priapism associated with risperidone. In this case, the treatment of priapism includes discontinuation of the offending agent and drainage of the corpus cavernosum twice along with intracavernosal phenylephrine injections. It is important to educate patients on priapism as a possible side effect of medications. It is also important to consider previous episodes of medication-induced priapism when prescribing psychotropic medications as this may increase the patient's future risk of priapism.
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Priapism associated with iloperidone: a case report. Gen Hosp Psychiatry 2014; 36:451.e5-6. [PMID: 24726763 DOI: 10.1016/j.genhosppsych.2014.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/20/2022]
Abstract
Priapism is a known side effect of antipsychotics. The causal mechanism seems to be mediated through α1-adrenergic receptor blockade which many antipsychotics are known to possess. We present the first detailed case of iloperidone-induced priapism in a patient with bipolar disorder with psychotic features. His case highlights some of the important risk factors clinicians should consider when using iloperidone, as it may be the highest-risk antipsychotic for causing priapism given it is a very potent blocker of the alpha-adrenergic receptor.
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Eiland LS, Bell EA, Erramouspe J. Priapism associated with the use of stimulant medications and atomoxetine for attention-deficit/hyperactivity disorder in children. Ann Pharmacother 2014; 48:1350-5. [PMID: 24982313 DOI: 10.1177/1060028014541791] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review the association of priapism with stimulant medications and atomoxetine commonly used in the treatment of attention-deficit/hyperactivity disorder (ADHD). DATA SOURCES A comprehensive literature search was conducted through PubMed (1966-May 15, 2014) using the search terms priapism, methylphenidate, amphetamine, atomoxetine, attention-deficit disorder with hyperactivity, and pediatrics. Google Scholar, Scopus, and the Food and Drug Administration (FDA) Web site were also searched. References from identified literature were also reviewed. STUDY SELECTION AND DATA EXTRACTION All identified literature focused on ADHD treatment. Literature regarding priapism caused by methylphenidate, amphetamines, and atomoxetine were included. DATA SYNTHESIS Stimulant medications and atomoxetine have been linked to the occurrence of priapism in children. Specifically, methylphenidate has been implicated in a recent FDA safety announcement warning as a result of 15 case reports (mean age = 12.5 years), and thus, the drug label and medication guides have been updated to reflect this concern. Prolonged erections and priapism occurred with immediate- and long-acting products, dose increases, and drug withdrawal periods. Priapism has also occurred in 4 patients taking amphetamines and one 11-year-old patient taking atomoxetine for ADHD. CONCLUSIONS Priapism has been associated with stimulants, amphetamines, and atomoxetine use for ADHD in children. Providers and health care practitioners should educate male patients prescribed these ADHD medications as well as caregivers regarding the signs, symptoms, and complications with priapism. Discontinuation and evaluation of the medication is warranted if this adverse drug reaction occurs. Depending on the priapism subtype, other products may be initiated or medications not associated with priapism may be utilized.
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Affiliation(s)
- Lea S Eiland
- Auburn University Harrison School of Pharmacy, Huntsville, AL, USA
| | - Edward A Bell
- Drake University College of Pharmacy, Des Moines, IA, USA
| | - John Erramouspe
- Idaho State University College of Pharmacy, Pocatello, ID, USA
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[Antipsychotic-induced priapism and management challenges: a case report]. Encephale 2014; 40:518-21. [PMID: 24709224 DOI: 10.1016/j.encep.2013.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/27/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Priapism is a persistent, and often painful, penile erection, lasting more than 3 hours, not usually associated with sexual stimuli. It is a urological emergency that can cause serious complications. Drugs are responsible of the onset of 25 to 40% of cases of priapism. Several classes of medication are involved: antidepressants, antihypertensives, anticoagulants, alpha-blockers and some psychoactive substances (alcohol, cocaine, cannabis...). However, about 50% of drug related priapism is due to antipsychotics (AP). Clinicians should be aware of this rare side effect because of the severity of its complications and the difficulty of its management, especially in non-stabilized psychotic patients. CASE REPORT We report a case of a 22-year-old male Moroccan patient, diagnosed with schizophrenia, who had been admitted for the first time to a psychiatric hospital for management of a psychotic episode. First, he received 15 mg per day of haloperidol, and seven days later he developed priapism. The patient was immediately referred for urological care. Aspiration and irrigation of the corpora cavernosa was proposed, but could not be performed because of patient refusal, and the erection resolved spontaneously after 10 hours. Haloperidol was stopped, and four days later the patient was switched to 10mg per day of olanzapine. After 10 days of treatment, he developed a second episode of priapism, and olanzapine was also stopped. A cavernosal aspiration-irrigation was performed in emergency; which resulted in the partial detumescence of the penis. Two days later, and despite therapeutic abstention, the patient presented another episode of priapism. The indication of a revascularization of the corpora cavernosa was proposed, but again the patient refused the surgery. Finally, the patient was administered 400mg/day of amisulpride, with a favorable outcome. Priapism disappeared after a month with the installation of fibrosis and partial loss of erectile function. DISCUSSION The precise mechanisms of the role of AP in the occurrence of priapism are not all known and a multifactor etiology seems the most likely. Neuromuscular hypothesis is the most mentioned, involving the blocking action of alpha1-adrenergic receptors of the corpora cavernosa for which most of AP have an affinity. The occurrence of priapism in a psychotic patient, especially during periods of decompensation, raises a number of challenges for the medical staff. First, the non-recognition by the patient of this side effect, and its potentially severe consequences. Second, the absence of link between dose and duration of AP treatment on one side, and the onset of priapism on the other, which makes it hard to predict. The third challenge is the choice and initiation of another AP. The literature reveals many cases of priapism in both conventional and atypical AP, the presence of a predisposition to this type of incident has been reported. However, few authors have focused on alternatives to provide for these patients. Amisulpride is currently the only molecule that does not have alpha-adrenergic affinity and is therefore preferred in these cases. CONCLUSION Priapism is a rare but serious adverse event of AP medication. Informing patient about the risk of priapism would help to report it early and prevent erectile dysfunction. Switching to another AP with less alpha1-blocking properties is generally recommended.
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Prolonged penile erections associated with the use of atomoxetine and aripiprazole in an 11-year-old boy. J Clin Psychopharmacol 2014; 34:275-6. [PMID: 24577257 DOI: 10.1097/01.jcp.0000445185.90518.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karamustafalioglu N, Kalelioglu T, Tanriover O, Gungor FC, Genc A, Ilnem C. A case report of priapism caused by ziprasidon. Psychiatry Investig 2013; 10:425-7. [PMID: 24474994 PMCID: PMC3902163 DOI: 10.4306/pi.2013.10.4.425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/07/2013] [Accepted: 02/11/2013] [Indexed: 11/19/2022] Open
Abstract
Priapism is defined as having prolonged (more than 6 h), and usually painful penile erection that occurs without a sexual desire or arousal. Only a very few priapism cases caused by ziprasidone are reported in the literature. In this case report we aimed to present a prolonged penile erection due to use of ziprasidone.
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Affiliation(s)
- Nesrin Karamustafalioglu
- Department of Psychiatry Bakirkoy Mental Health Training And Research Hospital, Bakirkoy-Istanbul,Turkey
| | - Tevfik Kalelioglu
- Department of Psychiatry Bakirkoy Mental Health Training And Research Hospital, Bakirkoy-Istanbul,Turkey
| | - Ozlem Tanriover
- Department of Family Medicine, Yeditepe University School of Medicine, Kadikoy-Istanbul, Turkey
| | - Ferda Can Gungor
- Department of Psychiatry Bakirkoy Mental Health Training And Research Hospital, Bakirkoy-Istanbul,Turkey
| | - Abdullah Genc
- Department of Psychiatry Bakirkoy Mental Health Training And Research Hospital, Bakirkoy-Istanbul,Turkey
| | - Cem Ilnem
- Department of Psychiatry Bakirkoy Mental Health Training And Research Hospital, Bakirkoy-Istanbul,Turkey
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Kashyap GL, Nayar J, Bashier A, Varghese S. Treatment of clozapine-induced priapism by goserline acetate injection. Ther Adv Psychopharmacol 2013; 3:298-300. [PMID: 24167706 PMCID: PMC3805388 DOI: 10.1177/2045125313488132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Clozapine (Denzapine) is a treatment for resistant schizophrenia. Among the serious but rare side effects of clozapine are agranulocytosis and priapism. We hereby present the case of a 30-year-old man with a diagnosis of schizophrenia who has spent nearly 12 years of his adult life on various psychiatric in-patient units including open wards, secure units, psychiatric intensive care units and rehab wards. Diagnosed at the age of 15, he only responded to clozapine at the age of 18. Whilst being on clozapine he developed priapism in June 2010 and needed emergency surgical treatment in the form of surgical decompression. He again responded only to clozapine and fortunately he did not redevelop priapism; however, he was readmitted in February 2011 due to relapse, and he remained resistant to other antipsychotics. He was rechallenged with clozapine and recovered, but unfortunately redeveloped priapism which required emergency surgical and medical intervention (goserline acetate and tinzaperin injection). In order to relieve the recurrent priapism, he agreed to continue clozapine and goserline acetate injection. This decision was made by the patient in a compos mentis state. As far as we are aware, this is the first time goserline acetate has been reported as a successful treatment for clozapine-induced priapism.
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Denton K, Kolli V, Sharma A. Ziprasidone-induced ischemic priapism requiring surgical intervention: a case report. Prim Care Companion CNS Disord 2013; 15:12l01443. [PMID: 23724347 DOI: 10.4088/pcc.12l01443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kevin Denton
- University of Nebraska Medical Center, Omaha, Nebraska, USA
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Pradhan T, Hardan A. Priapism associated with risperidone in a 21-year-old male with autism. J Child Adolesc Psychopharmacol 2013; 23:367-8. [PMID: 23738870 DOI: 10.1089/cap.2013.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Taniya Pradhan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.
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Paklet L, Abe AM, Olajide D. Priapism associated with risperidone: a case report, literature review and review of the South London and Maudsley hospital patients' database. Ther Adv Psychopharmacol 2013; 3:3-13. [PMID: 23983987 PMCID: PMC3736961 DOI: 10.1177/2045125312464104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Priapism is a urological emergency defined as persistent penile erection that is unrelated to sexual stimulation and typically involving only the corporal cavernosa. It can occur as a rare side effect of antipsychotic medications and is mediated via their α-adrenergic antagonist effect. In this paper we describe a case of priapism in a patient started on risperidone and sodium valproate. We also review the South London and Maudsley Case Register Interactive Search database to assess how many other cases of priapism were reported in patients taking risperidone. We add this information to a literature review of cases of priapism associated with risperidone.
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Hosseini SH, Bajoghli H, Ghaeli P. Effects of cigarette smoking on priapism induced by quetiapine: a case report. Daru 2012; 20:55. [PMID: 23352178 PMCID: PMC3555757 DOI: 10.1186/2008-2231-20-55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
Priapism is defined as an unwanted, prolonged, and painful erection which is unrelated to sexual stimulation. Some case studies suggest that priapism is an adverse effect of antipsychotic medications. In our case study a 30 year-old Iranian male with schizophrenia was experiencing recurrent priapism associated with quetiapine use. There are three interesting facts about this case: Firstly, the patient suffered priapism after even low dose consumption of quetiapine. Secondly, this case had experienced priapism with risperidone, olanzapine, and even clozapine in the past, suggesting a possible pharmacodynamic interaction of antipsychotics and inner biological traits in this particular case. Thirdly, priapism induced by low dose quetiapine was resolved after cigarette smoking.
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Affiliation(s)
- Seyed Hamzeh Hosseini
- Research Center for Rational Use of drugs, Faculty of Pharmacy, and Roozbeh Hospital, Tehran University of medical Sciences (TUMS), South Kargar St, 1333795914, Tehran, Iran.
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Dangle PP, Patel MB, Pandya LK, Firlit CF. A modified surgical approach to the Al-Ghorab shunt - an anatomical basis. BJU Int 2012; 109:1872-4. [PMID: 22612336 DOI: 10.1111/j.1464-410x.2012.11253.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pankaj P Dangle
- Department of Surgery, Division of Urology, Saint Louis University School of Medicine , Saint Louis, MO 63110-0250, USA.
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Priapism: comorbid factors and treatment outcomes in a contemporary series. Adv Urol 2012; 2012:672624. [PMID: 22811705 PMCID: PMC3395114 DOI: 10.1155/2012/672624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/05/2012] [Accepted: 05/08/2012] [Indexed: 01/22/2023] Open
Abstract
Objective. The goal of this study is to describe comorbid characteristics in patients who have priapism, and their treatment outcomes. Methods. Chart review was undertaken on men who had a diagnosis of priapism from a tertiary medical center, from 2000-2010. Men with priapism due exclusively to the use of prescription erectile aids and medications were not included in the review. Results. We identified 79 patients with the priapism. The most common type of priapism was the low flow variant. High flow priapism was identified in 2 patients. The most common general comorbid condition associated with priapism was mental illness (including substance abuse), which was present in 56% of the patients. Neurogenic priapism accounted for 19% of the total priapism events. Psychopharmaceutical agents and recreational drugs were commonly associated with ischemic priapism. Acute complications of priapism treatment were not common, but long-term complications, especially erectile dysfunction, were frequent. Conclusions. We describe the characteristics and outcomes of a large group of patients with priapism. Our experience at a tertiary care center indicates that mental illness, including substance abuse disorders, is a highly prevalent comorbid condition in men who experience priapism. Consistent with previous reports, erectile dysfunction is the most common complication from priapism and its treatment, occurring in the majority of men.
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Priapism in antipsychotic drug use: a rare but important side effect. Case Rep Psychiatry 2012; 2012:496364. [PMID: 22934218 PMCID: PMC3420524 DOI: 10.1155/2012/496364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022] Open
Abstract
Priapism is a rare but important side effect of antipsychotic drugs which may evolve into a urological emergency. Most antipsychotic drugs are alpha-1 adrenergic antagonists, which is thought to be the principal mechanism involved in antipsychotic-induced priapism. Other aetiologies exist, however. A case is presented with multiple episodes of priapism during the use of several different antipsychotic drugs. The case is representative of many patients treated with antipsychotic drugs, as there were hyperprolactinemia, and illicit drug use, which are known causes of priapism. Moreover, the patient used combinations of antipsychotic drugs. The case thus illustrates the etiological complexity which could delay a diagnosis of antipsychotic-induced priapism, and the problem of establishing a link between priapism and one particular ingredient of a drug combination. The case presents how a treatment regimen was finally established balancing antipsychotic efficacy to acceptable side effects and offers guidance to physicians regarding how antipsychotic-induced priapism may be resolved.
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Abstract
The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions.
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Affiliation(s)
- Jeffrey Dubin
- Department of Emergency Medicine, Washington Hospital Center, Georgetown University School of Medicine, Washington, DC 20010, USA.
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Dodds PR, Dodds TJ, Mohr MA. A case of relapsing priapism associated with long-acting injectable risperidone. Prim Care Companion CNS Disord 2011; 13:10l00995yel. [PMID: 21731842 DOI: 10.4088/pcc.10l00995yel] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Peter R Dodds
- Department of Surgery, Norwalk Hospital, Norwalk, CT, USA.
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