Antipsychotics
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Priapism: 19 case reports In a study of patients with priapism reported to the programme ’Arzneimittelsicherheit in der Psychiatrie’ (AMSP) between 1994 and 2016, 19 men (aged 24–53 years) were described, who developed priapism during treatment with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, promazine, quetiapine, risperidone, thioridazine, trazodone or zuclopenthixol [not all routes, dosages, time to reactions onsets and outcomes stated]. A 30-year-old man, who had schizophrenia, received aripiprazole 15 mg/day for 6 days. Then, the dose was increased to 30 mg/day for 5 days, followed by 45 mg/day. However, 1 month following the initiation of aripiprazole, he developed priapism that lasted for 3 days. He was then found to have developed erectile dysfunction. Treatment with aripiprazole was considered to have caused erectile dysfunction secondary to priapism. A 52-year-old man, who had a severe depressive episode with psychotic symptoms, started receiving aripiprazole 5 mg/day. He experienced several episodes of prolonged erections (priapism) during the first day of the aripiprazole therapy, and he discontinued aripiprazole by himself. The total duration of priapism was reported as 3 days. Treatment with aripiprazole was considered to have induced priapism. A 26-year-old man, who had paranoid schizophrenia, had been previously treated with clozapine without any development of priapism. Clozapine was re-initiated 3 months later at 200 mg/day for 3 days, followed by 500 mg/day for 3 days. However, on day 5 of the therapy, he developed priapism. Therefore, the dose of clozapine was reduced to 200 mg/day for 7 days. However, he developed another episode of priapism 6 days later. Eventually, surgical intervention was necessary. Treatment with clozapine was considered to have induced priapism. A 41-year-old man, who had a history of drug dependence, started receiving haloperidol 10mg. He developed priapism after a single dose of haloperidol and on the same day of haloperidol therapy. The total duration of priapism was reported as 2 days. He denied intake of alcohol or other drugs prior to this episode. Treatment with haloperidol was considered to have induced priapism. A 44-year-old man, who had a history of heavy alcohol abuse, started receiving haloperidol 5mg for alcohol dependence. He developed priapism after a single dose of haloperidol and on the same day of haloperidol. The total duration of priapism was reported as 5 days. Treatment with haloperidol was considered to have induced priapism. A 29-year-old man, who had schizophrenia, had been receiving olanzapine 10-15 mg/day for several months. He developed priapism after travelling abroad and shortly after marriage. The priapism was treated in a hospital with an unspecified sympathomimetic injection. The total duration of priapism was reported as >2hr. He continued olanzapine at a higher dose after the priapism was medically treated. No further sexual side effects occurred. Treatment with olanzapine was considered to have induced priapism.
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