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Priapism: urgent medical attention required

Priapism, an erection lasting several hours, needs to be diagnosed quickly in order to prevent possibly irreversible erectile dysfunction. It is often caused by medications.

Priapism is an abnormally persistent penile (or, more rarely, clitoral) erection lasting for several hours, which is not associated with sexual arousal or desire. In 95% of cases, this erection is painful and severe, with a risk of irreversible erectile dysfunction within 24 to 48 hours if left untreated.

In adults, medication is the most common identified cause of priapism. About 50% of drug-induced cases of priapism are caused by a neuroleptic drug. All neuroleptics can cause priapism, especially  chlorpromazine, olanzapine, oral or injectable paliperidone, risperidone or quetiapine. Priapism sometimes develops shortly after starting neuroleptic therapy, sometimes after prolonged exposure, sometimes after a change in dose.

Antidepressants such as fluoxetine can also cause priapism.

Other commonly used drugs expose patients to this serious adverse effect. For example: drugs used to treat erectile dysfunction, such as sildenafil and alprostadil; tamsulosin  and doxazosin, used in the treatment of enlarged prostate; or certain blood-pressure medications such as prazosin, labetalol or propranolol. Cases of priapism, including clitoral priapism, have also been reported with bupropion, a drug used in smoking cessation.

Other risk factors for priapism, including sickle cell disease (an inherited haemoglobin disorder), should be taken into account when considering the use of these drugs.

©Prescrire 1 September 2020

Source: "Drug-induced priapism" Prescrire International 2020; 29 (218): 210-213. Subscribers only.

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