title: [Priapism associated with antipsychotic medications: a series of four patients].
abstract: BACKGROUND
  Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.
  
  
  METHODS
  Between 1st January 2000 and 30th September 2007, four men (range 25/55 years), treated with antipsychotic agents (amisulpride, clozapine, levomepromazine, olanzapine, pipotiazine, risperidone or zuclopenthixol), presented one or several episodes of ischemic priapism. No other etiological factor was diagnosed. The patients were treated with aspiration and irrigation of the corpa cavernosa with intracavernous injection of sympathomimetic drugs followed in one case by a surgical distal cavernoglanular shunt.
  
  
  CONCLUSIONS
  Many conventional or atypical antipsychotic agents have been reported to cause priapism. Drug-induced priapism comprised of about 30% of the cases and an estimated 50% of them occurred with antipsychotic agents. The mechanism of priapism associated with antipsychotics agents thought to be related to alpha-adrenergic blocking properties. The decision of whether to restart a patient on a specific antipsychotic agent after an episode of priapism is a difficult clinical decision. An agent with low peripheral alpha-adrenergic blocking affinity would be preferred.
  
  
  CONCLUSIONS
  Ischemic priapism is an urologic emergency. Clinicians should be familiar with this rare but serious adverse event of antipsychotic agents to avoid long-term sequelae including erectile dysfunction.
authors.affiliation: Service urologie-andrologie, centre hospitalier régional La Source, B.P. 6709, 45067 Orléans cedex 2, France.
authors.forename: N
authors.initials: N
authors.lastname: Brichart
authors.forename: D
authors.initials: D
authors.lastname: Delavierre
authors.forename: M
authors.initials: M
authors.lastname: Peneau
authors.forename: H
authors.initials: H
authors.lastname: Ibrahim
authors.forename: A
authors.initials: A
authors.lastname: Mallek
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011317:Priapism / Q000139:chemically induced*
chemical_list: D014150:Antipsychotic Agents