[Priapism associated with antipsychotic medications: a series of four patients].
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.
Brichart
N
N
Service urologie-andrologie, centre hospitalier régional La Source, B.P. 6709, 45067 Orléans cedex 2, France.
Delavierre
D
D
Peneau
M
M
Ibrahim
H
H
Mallek
A
A
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011317:Priapism / Q000139:chemically induced*
D014150:Antipsychotic Agents