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Risperidone-Induced Priapism: A Systematic Review of Risk Factors, Comprehensive Assessment, and Management

Philipa Owusu-Antwi1, Muhialdain Muhialdain2, Priya Atodaria3

  • 1Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, Staten Island, NY.

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PubMed
Summary

Risperidone can cause priapism, a serious condition, regardless of dose or treatment length. Early recognition and management are crucial for preventing complications from this antipsychotic side effect.

Keywords:
adverse effectspharmacodynamicspriapismrisk managementrisperidone

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Area of Science:

  • Pharmacology
  • Urology
  • Psychiatry

Background:

  • Risperidone, a second-generation antipsychotic, has a high affinity for alpha-1 adrenergic receptors.
  • Priapism is a rare but severe urological emergency linked to risperidone use.
  • This adverse effect is often underrecognized in psychiatric care settings.

Purpose of the Study:

  • To synthesize published reports on risperidone-induced priapism.
  • To summarize the clinical characteristics of this condition.
  • To highlight strategies for prevention and management.

Main Methods:

  • A systematic literature search was performed across multiple databases (PubMed, EMBASE, Scopus, etc.) from 1957 to 2024.
  • Studies describing priapism following risperidone exposure were included; reviews and non-human studies were excluded.
  • Article screening and quality assessment were conducted independently by reviewers.

Main Results:

  • 58 studies involving risperidone-induced priapism were identified from 987 screened records.
  • Priapism occurred across all ages, doses, and treatment durations, with risk factors including sickle cell disease and substance use.
  • Management strategies ranged from conservative measures to surgical interventions; switching to lower alpha-1 affinity agents was effective.

Conclusions:

  • Risperidone-induced priapism can occur unexpectedly, leading to severe complications if not identified promptly.
  • Comprehensive patient evaluation before initiating risperidone is essential.
  • Increased clinician awareness and prompt management are vital for addressing this preventable adverse effect.