The Risk of Priapism with Medications: What You Need to Know

Written By Dr. David Danish

Managing mental and physical health conditions often involves the use of medications, but some treatments come with rare yet serious side effects. At Philadelphia Integrative Psychiatry, Dr. Danish and his team prioritize patient education and safety, ensuring that potential risks like priapism are thoroughly addressed. Priapism, a prolonged and often painful erection lasting more than four hours, can be caused by various medications and medical conditions. While rare, it is a urological emergency requiring prompt treatment to prevent long-term complications such as erectile dysfunction.

This blog explores the medications associated with priapism, the populations most at risk, and the mechanisms behind this condition. Drawing from sources like UCSF Health, Medscape, and peer-reviewed studies, we aim to provide a comprehensive understanding of this critical issue.

What Is Priapism?

Priapism is defined as an abnormal, persistent erection of the penis that occurs without sexual stimulation. It can be categorized into two main types:

  • Ischemic (low-flow) priapism: The most common type, caused by blood becoming trapped in the penis due to impaired venous drainage.

  • Non-ischemic (high-flow) priapism: A rarer form resulting from unregulated arterial blood flow into the penis, often due to trauma or injury.

If untreated, ischemic priapism can lead to tissue damage, fibrosis, and permanent erectile dysfunction[2][6].

Medications Associated with Priapism

Mental Health Medications

Psychiatric medications are a significant cause of drug-induced priapism due to their effects on alpha-adrenergic receptors or serotonin pathways:

  • Antidepressants: Trazodone is the most commonly implicated antidepressant, followed by SSRIs (e.g., fluoxetine, sertraline) and other agents like bupropion[3][10].

  • Antipsychotics: Both typical (e.g., chlorpromazine) and atypical antipsychotics (e.g., risperidone, clozapine) have been linked to priapism. These drugs block alpha-1 adrenergic receptors in the penile tissue[3][25].

  • Anxiolytics: Hydroxyzine has been reported as a rare cause.

  • Psychostimulants: Medications like methylphenidate used for ADHD may also pose a risk[1][7].

Medical Health Medications

Certain non-psychiatric drugs also increase the risk of priapism:

  • Erectile Dysfunction Medications: PDE5 inhibitors (e.g., sildenafil, tadalafil) are well-known contributors.

  • Alpha-Adrenergic Blockers: Drugs like prazosin and tamsulosin used for hypertension or prostate issues can cause priapism through vascular mechanisms[6][28].

  • Hormonal Therapies: Testosterone and gonadotropin-releasing hormone agonists may increase risk.

  • Anticoagulants: Heparin and warfarin are associated with vascular complications that can lead to priapism.

  • Others: Recreational drugs such as cocaine and alcohol have also been implicated[4][19].

Populations Most at Risk

Certain groups are more predisposed to developing priapism:

  1. Individuals with Sickle Cell Disease (SCD): SCD accounts for up to 40% of all priapism cases in adults and children. It is particularly common in males of African descent[6][31].

  2. Age Group: Men in their 30s are at higher risk due to increased use of medications like antidepressants and antipsychotics[9].

  3. Comorbid Conditions: Hematological disorders (e.g., leukemia), hypercoagulable states, and trauma increase susceptibility.

  4. Medication Users: Patients on multiple drugs with alpha-blocking activity face additive risks[3][28].

Mechanisms Behind Priapism

The primary mechanism of drug-induced ischemic priapism involves the blockade of alpha-1 adrenergic receptors in penile smooth muscle. This leads to unregulated vasodilation and impaired venous outflow from the corpora cavernosa[3][10]. For example:

  • Antipsychotics like risperidone exhibit high binding affinity for alpha-1 receptors, increasing their likelihood of causing priapism.

  • Trazodone’s dual action on serotonin pathways and alpha receptors makes it particularly risky[25].

Preventing and Managing Priapism

To minimize risk:

  • Providers should evaluate patient history for risk factors such as SCD or prior episodes of priapism.

  • Avoid combining multiple medications with alpha-blocking properties when possible.

  • Educate patients about early symptoms of priapism and emphasize seeking immediate care if an erection lasts more than four hours.

Treatment includes immediately going to the ER to receive intracavernosal injection of phenylephrine for ischemic cases or surgical intervention if conservative measures fail[6][28].

Getting in Touch with Dr. Danish and His Team

At Philadelphia Integrative Psychiatry, we are committed to providing safe, holistic care tailored to each patient’s needs. By staying informed about medication risks like priapism, we ensure our patients receive comprehensive guidance for their mental health journey. If you or a loved one has concerns about medication side effects or mental health challenges, please text or call 610-999-6414 to learn how we can help.


For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:

Dr. David Danish
Next

The Link Between SSRIs and Bone Health: What Patients Need to Know