olanzapine 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

Topics: Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Priapism; Risperidone; Schizophrenia; Treatment Outcome

We present a case of intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine. It demonstrates rapid intervention in a stepwise approach aiming to restore penile flaccidity in order to prevent chronic damage to the corpora cavernosa. After an unsuccessful conservative approach, our patient underwent two formal distal penile shunt procedures with no effective penile detumescence. Subsequently, bilateral proximal penile shunts were performed comprising a right corpus cavernosum to corpus spongiosum anastomosis and a left saphenous vein to left corpus cavernosum anastomosis. The patient remained an inpatient for observation, and detumescence was gradually achieved over several days after this procedure. However, follow-up revealed erectile dysfunction, and it was explained to the patient that he was unlikely to achieve further erections and that a penile implant was the only realistic option.

Topics: Adult; Antipsychotic Agents; Humans; Male; Olanzapine; Penis; Priapism; Prisoners; Treatment Outcome; Urologic Surgical Procedures, Male

Topics: Antipsychotic Agents; Fluphenazine; Humans; Male; Middle Aged; Olanzapine; Priapism; Risperidone

Priapism is a potentially painful and prolonged erection that occurs in the absence of any stimulation. Olanzapine has been reported to induce priapism in several adult cases with schizophrenia and/or mood disorders but very rarely reported in children.. 9-year-old male with Asperger's Syndrome (AS) referred to our clinic with the complaints of inattention, hyperactivity and impulsivity. He was diagnosed with attention deficit hyperactivity disorder (ADHD) and given methylphenidate treatment which ameliorated his ADHD symptoms. He started to have severe loss of appetite after methylphenidate treatment so olanzapine 2.5 mg/day was added to cope with severe inappetence. However he experienced priapism after olanzapine and priapism resolved after ceasing the drug. His mother restarted olanzapine because he benefited from olanzapine. But the same episodes occurred soon after olanzapine again and his mother had to stop the medication.. Because atypical antipsychotics are now widely used in children, unusual side effects such as priapism should be taken into consideration for the differential diagnosis.

Topics: Antipsychotic Agents; Asperger Syndrome; Attention Deficit Disorder with Hyperactivity; Benzodiazepines; Child; Humans; Male; Olanzapine; Priapism

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.. 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.. 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.. 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.

Topics: Antipsychotic Agents; Benzodiazepines; Drug Substitution; Follow-Up Studies; Haloperidol; Hospitals, Psychiatric; Humans; Male; Morocco; Olanzapine; Priapism; Recurrence; Schizophrenia; Schizophrenic Psychology; Treatment Refusal; Young Adult

Topics: Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Humans; Male; Olanzapine; Priapism; Young Adult

Priapism is a rare but serious adverse effect of psychotropic drugs where antipsychotic agents were implicated in 15 to 26% of priapism associated with medications. Among atypical antipsychotic, clozapine, risperidone and olanzapine have been reported to be associated with the condition. The patient was a 24-years-old male referred to the OPD Clinic at Zare Psychiatry Hospital in 2007 with symptoms of delusion of control, delusion of persecution, delusion of somatic and auditory hallucination, for the last year. He had priapism following the use of olanzapine. Serotonin-Dopamine Antagonist (SDA) should be proscribed with care became of this rare yet serious complication, especially in cases with previous history of priapism following the use of psychotropic drugs.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Male; Mental Disorders; Olanzapine; Priapism; Selective Serotonin Reuptake Inhibitors; Young Adult

In this article, a 14-year-old boy with priapism is presented. A secondary low-flow type of priapism, persisting 11 hours, as a result of olanzapine and methylphenidate therapy was diagnosted. There was a good response to conservative treatment (diazepam, metamisolum), detumescence appeared in 3 hours. No recurrence of priapism was observed, after the olanzapine and methylphenidate therapy was stopped.

Topics: Adolescent; Benzodiazepines; Central Nervous System Stimulants; Humans; Male; Methylphenidate; Olanzapine; Priapism; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Carbamazepine; Humans; Iatrogenic Disease; Lithium Carbonate; Male; Olanzapine; Priapism

Excluding nicotine and caffeine dependence, almost 50% of individuals with schizophrenia also meet the criteria for substance abuse or dependence. Comorbid drug abuse presents complications to the effective treatment of these patients because they have increased psychotic symptoms and poorer treatment compliance.. This report describes thecase of a young man with schizophrenia and comorbid alcohol and cocaine abuse who was successfully treated with quetiapine. The patient was previously treated with olanzapine and developed priapism, which required emergency medical treatment.. The possible utility of atypical antipsychotics in the treatment of patients with schizophrenia and comorbid substance abuse needs to be confirmed in clinical trials.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Black or African American; Contraindications; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Humans; Male; Olanzapine; Pirenzepine; Priapism; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Polypharmacy; Priapism; Risperidone; Schizophrenia; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pirenzepine; Priapism; Schizophrenia, Disorganized

Topics: Adult; Benzodiazepines; Erectile Dysfunction; Humans; Male; Olanzapine; Pirenzepine; Priapism; Psychotic Disorders; Recurrence; Reoperation

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

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pirenzepine; Priapism