Aripiprazole-induced priapism

Priapism in a 31-Year-Old Male With Paranoid Schizophrenia

Priapism is a painful and emergent side effect that has been linked to some antipsychotics and other psychiatric medications, most often trazodone. This is thought to be due to some level of alpha-1 adrenergic blockade by these medications. Aripiprazole is an atypical antipsychotic with notably weak alpha-1 adrenergic antagonism. Thus, we report on a unique case of aripiprazole-induced priapism in a patient with schizophrenia and recurrent episodes of antipsychotic-induced priapism. This study offers insight into the potential mechanism of aripiprazole-induced priapism and offers alternative medications, such as olanzapine and lumateperone, to treat the patient's ongoing psychotic disorder.

Recurrent Priapism Due to Paliperidone Palmitate Use: A Case Report

Priapism is a painful and prolonged erection of the penis without sexual stimulation. Priapism can be seen due to both typical and atypical antipsychotic drug use. A 51-year-old male who was followed up with a diagnosis of schizophrenia for 30 years and was switched from oral aripiprazole to paliperidone palmitate due to psychotic exacerbation was reported in this study. About 1 month after starting the drug, the patient presented to the emergency department with a painful and prolonged penile erection lasting 3-4 hours. Following the diagnosis of priapism by urology, the patient was relieved by intracavernous adrenaline injection and corpus cavernosum drainage and was referred to psychiatric consultation. Since the patient's examination, history, and laboratory tests could not detect a condition that could cause priapism, it was thought that priapism might be due to antipsychotic medication. One week after stopping paliperidone palmitate injection, the patient had another attack of priapism. Ten days after the second priapism, the patient was started on olanzapine, 10 mg/day, which was increased to 20 mg/day in the follow-up. The patient has been using olanzapine 20 mg/day for the past year. He is still psychiatrically stable and has no signs of priapism. To the best of our knowledge, this is the second case of recurrent priapism associated with paliperidone palmitate use.

A very rare case of priapism under aripiprazole in a patient followed for bipolar disorder: A CARE-compliant report

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.

Aripiprazole-induced Hepatitis: A Case Report

Aripiprazole is an atypical antipsychotic that acts as a partial agonist of dopamine type 2 receptors as well as 5-HT1A receptors. It is used in the treatment of schizophrenia and in type 1 bipolar disorder for mania. Because aripiprazole is well tolerated with few side effects it is used off-label in other psychotic disorders. The prevalence of abnormal liver function tests with antipsychotic use is 32%, with clinically significant effects in 4% of cases. No cases of aripiprazole-induced liver injury have been published. We report a 28-year-old female who presented with non-affective first-episode psychosis and who was treated with aripiprazole. Initially she was medicated with 10 mg per day, with an increase to 20 mg per day on the 12th day of hospitalization. Nine days after she became icteric, with nausea and had a vomiting episode. Laboratory analysis revealed a very high level of alanine aminotransferase, and minor to moderately high levels of aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. Aripiprazole was tapered and paliperidone was started with the improvement of clinical and laboratory findings.

Polypharmacy Leading to Priapism in HIV Patient with Schizoaffective Disorder: A CYP450 Cascade

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.