[Antipsychotic-induced priapism and management challenges: a case report]

Area of Science:

• Pharmacology
• Urology
• Psychiatry

Background:

• Priapism, a persistent erection lasting over 3 hours, is a urological emergency often linked to medications.
• Antipsychotics (AP) account for approximately 50% of drug-induced priapism cases, necessitating clinical awareness due to potential severe complications.

Observation:

• A case report details a 22-year-old male with schizophrenia who developed priapism after initiating haloperidol, and subsequently olanzapine.
• Both haloperidol and olanzapine were discontinued due to recurrent priapism episodes, with the patient refusing invasive treatments.
• The patient eventually received amisulpride, leading to the resolution of priapism, though with resultant fibrosis and partial erectile dysfunction.

Findings:

• Antipsychotic-induced priapism is a rare but serious adverse event, with multifactorial etiology likely involving alpha1-adrenergic receptor blockade.
• The onset of priapism is unpredictable, showing no clear correlation with AP dose or treatment duration, posing management challenges.

Implications:

• Early patient education on the risk of priapism is crucial for prompt reporting and prevention of long-term erectile dysfunction.
• Switching to an antipsychotic with minimal alpha1-blocking properties, such as amisulpride, is recommended for patients experiencing priapism.