quetiapine-fumarate and Priapism

Priapism is characterized by a prolonged and painful erection in the absence of sexual desire and arousal. Priapism is a rare and serious side effect of psychotropic drugs, and is thought to be attributable to blockage of alpha-1 adrenergic receptors in the corpus cavernosum. Although priapism is commonly associated with typical antipsychotics, there are some (but not many) case reports of priapism due to atypical antipsychotics. This side effect has been reported in patients taking ziprasidone, risperidone, clozapine, quetiapine, aripiprazole, and olanzapine. Not all antipsychotics bind to alpha-1 adrenergic receptors with the same intensity; as compared to other antipsychotics, quetiapine has an intermediate affinity. Priapism could be considered an idiosyncratic reaction, because it is correlated neither with the dose nor duration of psychotropic drug use. Herein we present a case of priapism caused by a single 300-mg dose of quetiapine, and a brief review priapism in the light of this case.

Topics: Administration, Oral; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Drug Administration Schedule; Humans; Male; Middle Aged; Priapism; Quetiapine Fumarate

We report a case of priapism occurring in a patient taking a standard daily dose of the atypical antipsychotic quetiapine (Seroquel). To our knowledge, this represents the second published report associating quetiapine with priapism, and the first to associate priapism with routine dosing of the drug. Previously published studies have suggested that alpha-adrenergic blockade may be the mechanism of action for this side effect. We report successful management in this case with cavernosal aspiration followed by intracavernosal injection of phenylephrine.

Topics: Antipsychotic Agents; Dibenzothiazepines; Humans; Male; Priapism; Quetiapine Fumarate

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

Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. Priapism has been established as a rare adverse drug reaction to drugs such as antipsychotics, psychostimulants, antidepressants, and mood stabilizers. Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems. Antipsychotic-induced priapism may result from the alpha receptor occupancy property of those drugs. We report the case of a 13-year-old suffering from attention deficit-hyperactivity disorder plus conduct disorder with priapism related to antipsychotics. Episodes occurred with risperidone plus methylphenidate, quetiapine plus methylphenidate, and chlorpromazine alone.

Topics: Adolescent; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Chlorpromazine; Drug Therapy, Combination; Humans; Male; Penis; Priapism; Quetiapine Fumarate; Risperidone; Ultrasonography, Doppler

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Humans; Lithium; Male; Penile Erection; Priapism; Quetiapine Fumarate

Topics: Adult; Antipsychotic Agents; Humans; Ischemia; Male; Priapism; Quetiapine Fumarate

Priapism is rarely related to use of non-erectile related medications. The objective was to educate about the multiple possible causes of priapism and to provide treatment recommendations for the different types of priapism. We present the case of a 43-year-old African American male with a history of schizoaffective disorder who presented to our emergency department multiple times over a three year period with priapism, each episode related to the ingestion of quetiapine. Following penile aspiration and intercavernosal injection of phenylephrine, this patient had resolution of his priapism. This case demonstrates an unusual case of recurrent priapism.

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Emergency Service, Hospital; Humans; Male; Priapism; Psychotic Disorders; Quetiapine Fumarate; Recurrence

Topics: Adult; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Male; Priapism; Quetiapine Fumarate

Topics: Dibenzothiazepines; Humans; Male; Middle Aged; Phenylephrine; Priapism; Quetiapine Fumarate; Recurrence

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

Topics: Amphetamine-Related Disorders; Antipsychotic Agents; Depressive Disorder, Major; Dibenzothiazepines; HIV Seropositivity; Humans; Male; Middle Aged; Priapism; Quetiapine Fumarate

Priapism is a "persistent erection not accompanied by sexual desire or stimulation, usually lasting more than six hours and typically involving only the corpora cavernosa." Here we report on a gay male patient from our HIV/AIDS mental health clinic who developed serious priapism on quetiapine and recreational amphetamine. Gay men are at high risk for amphetamine use, and as such, this potential association between priapism, quetiapine, and amphetamine use should be considered in making prescription decisions with these patients.

Topics: Amphetamine; Amphetamine-Related Disorders; Antipsychotic Agents; Comorbidity; Depressive Disorder; Dibenzothiazepines; Drug Interactions; Drug Therapy, Combination; HIV Seropositivity; Homosexuality, Male; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Priapism; Psychotic Disorders; Quetiapine Fumarate

Topics: Adult; Dibenzothiazepines; Drug Therapy, Combination; Humans; Male; Priapism; Quetiapine Fumarate; Risperidone; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Trazodone

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

We report a case of priapism occurring after an overdose of the newly approved atypical antipsychotic quetiapine. A review of its previously published receptor-binding studies suggests that alpha-adrenergic blockade may be the responsible mechanism. To our knowledge, this is the first report of priapism associated with quetiapine, and we recommend the inclusion of priapism in its list of potential adverse effects in cases of overdose.

Topics: Adrenergic alpha-Antagonists; Antipsychotic Agents; Dibenzothiazepines; Drug Overdose; Humans; Male; Middle Aged; Priapism; Quetiapine Fumarate; Receptors, Adrenergic, alpha; Suicide, Attempted