Olanzapine-Associated Priapism

Abstract

Back to table of contents Previous article Next article LettersFull AccessOlanzapine-Associated PriapismLokesh Shahani, M.D.Lokesh ShahaniDept. of Internal MedicineSIU School of MedicineSpringfield, ILSearch for more papers by this author, M.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11100251AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Priapism is defined as painful, persistent, and prolonged penile erection. It has been associated with long-term devastating consequences such as impotence, gangrene, and urinary retention. Psychotropic medication, notably, trazodone, is well known for its side effect of priapism; however, antipsychotic medications have also been reported to cause priapism.1A 24-year-old African American man with a history of bipolar disorder presented with a severe manic episode associated with psychotic symptoms. He was on valproic acid with good results in the past, however had been noncompliant with his medication for 2 weeks prior to his presentation. He denied any substance use, and his urine toxicology screen was negative. There were no concomitant medical problems, and home medication list was restricted to valproic acid. The patient was hospitalized, and valproic acid was resumed. Olanzapine 5 mg at bedtime was started as an augmentation agent for his severe manic episode. On the mornings of Day 3 and 4 of hospital stay, the patient complained of prolonged, painless erection not associated with any sexual behavior or thoughts. These episodes lasted for around 30 minutes and resolved without any intervention. However, on Day 5, the erection was painful and did not resolve up to 2 hours after the patient woke up in the morning. The urology service was consulted and immediate evacuation of blood from the patient’s penis was performed and phenylephrine was injected, achieving complete flaccidity. The Naranjo algorithm determined a probable association between olanzapine and priapism.2 Olanzapine was discontinued, and the patient was continued on valproic acid. He stabilized with regard to his mood disorder in the next 3 days and did not have a recurrence in the symptoms of prolonged erections. Olanzapine was documented in the medical records to cause this adverse reaction and was never administered in the future. The patient has not had recurrence of priapism in the next 2 years after his initial episode.Priapism results from alpha1-adrenergic blockade in the corpora cavernosa, leading to a parasympathetic-mediated arteriodilation, as well as inhibition of the sympathetic system that leads to detumescence. This leads to an intracavernosal stasis, owing to inadequate venous outflow caused by the obstruction of subtunical venules, resulting in hypoxia, acidosis, and pain.3 Alpha2-adrenergic blockade exacerbates the priapism by stimulating the release of a nitric oxide-like substance, which further stimulates erections.4 Antipsychotic-induced priapism has been linked to the alpha1-adrenergic antagonism of these medications. Olanzapine has both alpha1- and alpha2-blocking characteristics and has been associated with several similar cases.1 Clinicians prescribing antipsychotics should be aware and educate patients about this rare but serious adverse reaction of these medications.Dept. of Internal MedicineSIU School of MedicineSpringfield, ILCorrespondence: e-mail: [email protected]comReferences1 Sood S, James W, Bailon MJ: Priapism associated with atypical antipsychotic medications: a review. Int Clin Psychopharmacol 2008; 23:9–17Crossref, Medline, Google Scholar2 Naranjo CA, Busto U, Sellers EM, et al.: A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30:239–245Crossref, Medline, Google Scholar3 Segraves RT: Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry 1989; 46:275–284Crossref, Medline, Google Scholar4 Deirmenjian JM, Erhart SM, Wirshing DA, et al.: Olanzapine-induced reversible priapism: a case report. J Clin Psychopharmacol 1998; 18:351–353Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited bySexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review6 September 2022 | Schizophrenia Bulletin, Vol. 49, No. 1The Association Between Psychotropic Drug Use and Fertility Problems Among Male SubjectsJournal of Psychiatric Practice, Vol. 25, No. 1Priapism and Hypersexuality Associated With Rotigotine in an Elderly Parkinsonian PatientClinical Neuropharmacology, Vol. 39, No. 3Ninety-six hours ordeal of priapism induced by paroxetine—A case report and literature review5 October 2015 | The International Journal of Psychiatry in Medicine, Vol. 50, No. 3Reactions Weekly, Vol. 1441, No. 1 Volume 24Issue 4 Fall 2012Pages E28-E28 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012