Methylphenidate-induced erections in a prepubertal child

Abstract

Methylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencing a response-adjusted dosing regimen of sustained release methylphenidate. Despite priapism being a rare adverse reaction associated with methylphenidate, physicians and parents need to be aware as it can have significant long-term complications.

Methylphenidate-induced spontaneous ejaculation

“…Facilitating effects of psychostimulants and MPH on sexual function have been shown previously [Bilgiç et al 2007;Kelly et al 2013]. However, psychopharmacological mechanisms of stimulant-related ejaculation are not well studied.…”

“…Nevertheless it would be a reductionist approach if we claimed that the exact mechanism of this side effect is directly due to dopamine increase. İn recent case reports, some sexual side effects, such as priapism and hypersexual behaviour, associated with MPH Therapeutic Advances in Psychopharmacology 5 (1) was related to the cessation of the drug [Kelly et al 2013;Coşkun and Zoroglu, 2009]. Furthermore, dopamine is more related to the first (libido) and the second stage of sexual response (arousal and erection).…”

“…Besides common side effects such as insomnia and loss of appetite, there are some rare side effects such as sexual dysfunction. Priapism, hypersexuality and excessive masturbation in children and spontaneous erection in adults have been reported with MPH [Bilgiç et al 2007;Kelly et al 2013]. Oosterhuis and colleagues reported spontaneous ejaculation in a 25-year-old man with MPH [Oosterhuis et al 2009].…”

From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate

“…However, due to limitations in available information, it is not known how frequently priapism appears in patients treated with MPD. Cases of a prepubertal child and a 14-year-old male who developed priapism after therapy with MPD have been reported in literature [ 88 , 89 ]. It is recommended that healthcare professionals should inform male patients about the symptoms and signs of priapism and emphasize the necessity for immediate treatment, since younger males may not recognize the problem or be too embarrassed to tell anyone if it happens [ 90 ].…”

Pediatric Priapism Secondary to Psychotherapeutic Medications

“…4 In addition, the Food and Drug Administration has acknowledged multiple cases of priapism in children taking atomoxetine and reports that priapism may be more common with atomoxetine than with the more often associated methylphenidate. 13,15 Biochemical changes in peripubertal males could alter the priapism risk, which could explain why priapism can occur in children on stable medication doses.…”