A Case of Relapsing Priapism Associated With Long-Acting Injectable Risperidone

Dodds, Peter R.; Dodds, Tyler J.; Mohr, Michael A.

doi:10.4088/pcc.10l00995yel

Cited by 4 publications

(3 citation statements)

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“…Relapsing priapism from long-acting risperidone has been documented within the literature. 6,7 Multiple case reports on risperidone-induced priapism have shown this phenomenon may occur days to even years after starting this medication, even with low, stable doses. 4,8 The patient was also receiving concomitant oral risperidone with risperidone long-acting injection, possibly leading to levels above the desired range.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic-Induced Priapism in a Treatment-Refractory Patient: A Case Report

Burk

Nelson

2019

Journal of Pharmacy Practice

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Purpose: A case report of multiple episodes of priapism associated with the use of 4 different psychotropic medications. Summary: 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). Conclusion: 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.

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Section: Discussionmentioning

confidence: 99%

Psychotropic-Induced Priapism in a Treatment-Refractory Patient: A Case Report

Burk

Nelson

2019

Journal of Pharmacy Practice

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“…3,11,44,55 In the published cases, most of the teams replaced risperidone with olanzapine, 13,29,31,32,46,49 aripiprazole 15,16,37 or clozapine. 28,41 Few teams chose haloperidol, 36 sulpiride, 44 quetiapine, 45 asenapine, 50 fluphenazine 34 or flupenthixol. 30 To date, no consensus has been reached on the best choice of drug.…”

Section: Therapeutic Advances In Psychopharmacologymentioning

confidence: 99%

Risperidone-induced priapism: a case report and literature review

Ateb

Fourati

Rejeb

et al. 2022

Therapeutic Advances in Psychopharmacology

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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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“…Although typical antipsychotics are thought to be related to priapism, there are some case reports on the relationship between atypical antipsychotics (e.g., risperidone, clozapine, ziprasidone, quetiapine, olanzapine, and aripiprazole) and priapism 5,6,7,8,9,10). In the literature, priapism has been been associated with risperidone administered at any stage of treatment and in different doses, alone or in combination with psychotropic drugs, and with long-acting injectable risperidone (2,11,12,13,14).…”

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confidence: 99%