clozapine and Priapism

Priapism is a prolonged, usually painful, and persistent penile erection not usually associated with sexual stimuli, resulting from a disturbance in the normal regulatory mechanisms that initiate and maintain penile flaccidity. This infrequent adverse event of antipsychotic medication use requires emergency evaluation and has potentially serious long-term sequelae including erectile dysfunction. Clinicians prescribing antipsychotic medications should be aware of this rare but serious adverse event.. A computerized search, using the MEDLINE database (1966-summer 2000), located cases of priapism associated with most conventional antipsychotics as well as with clozapine, risperidone, and olanzapine. The search included no restrictions on languages. Keywords included priapism combined with antipsychotic agents and the names of the currently available atypical antipsychotics. Twenty-nine publications were located using these parameters. Additional publications were reviewed for general background on pathophysiology, evaluation, and management. The quality of the evidence reviewed is limited by the observational and uncontrolled nature of case reports, case series. and review articles.. Psychotropic-induced priapism is currently believed to be caused by the alpha1-adrenergic antagonism of these medications. Detumescence is sympathetically mediated, and alpha1-adrenergic antagonism (within the corpora cavernosa) inhibits detumescence. The propensity of individual antipsychotics to induce priapism can presumably be estimated on the basis of alpha1adrenergic blockade affinities. Of the conventional antipsychotics, chlorpromazine and thioridazine have the greatest alpha1-adrenergic affinity and have been most frequently reported to be associated with priapism. Of the atypical antipsychotics, risperidone has greater alpha1-adrenergic affinity, although 3 of the 5 currently U.S. Food and Drug Administration (FDA)-approved atypicals have been reported to be associated with priapism.. Virtually all antipsychotic medications have been reported to rarely cause priapism due to their alpha-adrenergic antagonism. This adverse event should be considered a urologic emergency. Clinicians should be familiar with this infrequent serious adverse event of antipsychotic medications.

Topics: Antipsychotic Agents; Benzodiazepines; Circadian Rhythm; Clozapine; Erectile Dysfunction; Female; Forensic Psychiatry; Humans; Male; Olanzapine; Pirenzepine; Priapism; Psychotic Disorders; Risperidone

A case report of multiple episodes of priapism associated with the use of 4 different psychotropic medications.. A 34-year-old African American male with treatment-refractory schizoaffective disorder suffered priapism on 6 separate occasions. His medical history is relatively unremarkable, with the exception of possible undiagnosed thalassemia. All incidences were potentially attributable to psychotropic medications, with chlorpromazine, risperidone, trazodone, and quetiapine being the most likely culprits. The onset of priapism ranged from hours after a single injection of chlorpromazine, to years after multiple injections of risperidone, with nothing to indicate a medication dose or duration relationship to priapism. While on clozapine, fluphenazine, haloperidol, lurasidone, and olanzapine at varying times, the patient did not appear to develop priapism. The commonality of high-affinity alpha-1 antagonism with these psychotropics may be to blame. No pharmacokinetic or pharmacodynamic interactions were noted, which would have produced elevations in the levels of these psychotropics, nor was the patient on any phosphodiesterase type 5 (PDE-5) inhibitors or antihypertensives known to cause priapism. Depending on the offending agent, the Naranjo et al's Adverse-Reaction Probability Scale scores ranged from 5 to 8 (probable).. A man suffered from multiple episodes of priapism attributed to psychotropic medications. This is not the first case to describe this effect, but will give clinicians a timeline of events and medications that did and did not appear to elicit priapism in a patient with treatment-refractory schizoaffective disorder. Knowledge of which psychotropic medications may be more likely to induce priapism is crucial to preventing long-term penile damage.

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Priapism; Quetiapine Fumarate; Risperidone

The following is a letter to the editor that represents a case of recurrent priapism. The patient received clozapine, quetiapine and haloperidol and had the adverse reaction of priapism, one episode of which required surgical intervention. This case highlights the need for physicians to be aware of the potential for this serious adverse effect and to be especially mindful to carefully monitor those patients who have already had one episode of priapism as they may be at risk for recurrence.

Topics: Adult; Antipsychotic Agents; Clozapine; Dibenzothiazepines; Haloperidol; Humans; Male; Priapism; Quetiapine Fumarate; Recurrence

A man affected by schizoaffective disorder and alcohol abuse presented priapism after eleven years of clozapine treatment. After surgical intervention and resolution of priapism, he continued clozapine treatment at the same dose without problems. Clozapine withdrawal is not mandatory in patients who develop priapism in the course of treatment.

Topics: Adult; Alcoholism; Antipsychotic Agents; Clozapine; Humans; Male; Priapism; Psychotic Disorders; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Humans; Male; Priapism; Psychotic Disorders; Recurrence

Topics: Adult; Clozapine; Dose-Response Relationship, Drug; Humans; Long-Term Care; Male; Priapism; Schizophrenia, Paranoid

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Interactions; Humans; Male; Olanzapine; Pirenzepine; Priapism; Psychotic Disorders

We present the case of a 35-year-old patient suffering from schizoaffective psychosis. After 4 weeks on clozapine he developed acute priapism. Possible explanations and pathophysiology are discussed as well as the requirement for sufficient information of the patient. Delay of urgent urologic treatment increases the risk of irreversible impotence. The patient's history should be evaluated with respect to former unphysiological prolonged erections.

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Clozapine; Humans; Male; Priapism; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

Topics: Adult; Clozapine; Humans; Long-Term Care; Male; Priapism; Schizophrenia, Paranoid

Topics: Adult; Clozapine; Drug Therapy, Combination; Haloperidol; Humans; Libido; Male; Penile Erection; Priapism; Schizophrenia; Schizophrenic Psychology

Priapism may be a side effect of certain medications. We present a case of priapism associated with the nonphenothiazine antipsychotic drug clozapine. The possible mechanism for the drug-induced priapism is discussed.

Topics: Adult; Clozapine; Humans; Male; Priapism

Priapism is a recognized side effect of antipsychotic therapy. Recently, new agents known as atypical antipsychotics, such as clozapine, have been introduced with the intent of ameliorating psychosis without the extrapyramidal side effects associated with standard antipsychotic therapy. Priapism has not been observed previously with atypical antipsychotic therapy. We report a case of veno-occlusive priapism associated with the use of clozapine. This priapistic episode was complicated by the development of recurrent post-ischemic priapism.

Topics: Adult; Clozapine; Humans; Male; Priapism; Recurrence

Topics: Adult; Auditory Perceptual Disorders; Clozapine; Hallucinations; Humans; Intellectual Disability; Male; Priapism