[Priapism caused by simultaneous use of zuclopentixol and paroxetine]

A man aged 32 with psychotic and depressive symptoms was treated with zuclopentixol and paroxetine, following which priapism developed. After puncture of coagulated blood from the corpora cavernosa urine retention developed and a suprapubic catheter had to be introduced temporarily for urine drainage. Zuclopentixol is an alpha 1-receptor blocker and paroxetine inhibits the hepatic enzyme P450-2D6 required for conversion of the two substances. Separately, and especially in combination, these substances cause a disturbance of the drainage from the corpora cavernosa leading to ischaemia and complications such as dysuria, urine retention, impotence, fibrosis of the corpora cavernosa and gangrene. Consequently, timely treatment is indicated.