Priapism painful erection

Priapism Prolonged erections more than 4 hours and priapism (painful erections more than 6 hours in duration) have been infrequently reported. In the event of an erection that persists more than 4 hours, advise the patient to seek immediate medical assistance. 

Prolonged erections (lasting over 4 hr) and priapism (painful erections lasting over 6 hr) occur rarely. 

Priapism A prolonged, often painful erection of the penis. 

Trazodone has structural similarities with TCAs but probably acts by antagonism of postsynaptic serotonin receptors and presynaptic a-adrenoceptors. It is an option for depressed patients where heavy sedation is required. Trazodone also has the advantages of lacking antimuscarinic effects and being relatively safe in overdose. Males should be warned of the possibility of priapism (painful penile erections), attributable to the drug s blockade of ttj-adrenoceptors. 

Prolonged painful erections (priapisms) have been rarely reported. ... 

Sickling in the sinusoids of the penis can cause priapism, a sustained painful erection that may last several hours or days. Impotence has been reported after repeated episodes. ASPEN (association of fickle cell disease, priapism, exchange transfusion, and neurological events) syndrome has occurred in some patients with priapism after partial exchange transfusion. The syndrome can range from headaches and seizures to obtundation requiring ventilation. ... 

There appear to be no published reports of adverse interactions between intracavemous alprostadil (prostaglandin E,) and other drugs used for erectile dysfunction, but some manufacturers say that smooth muscle re-laxants such as papaverine and other drugs used to induce erections such as alpha-blocking drugs [e.g. intracavernosal phentolamine] should not be used concurrently because of the risks of priapism (painful prolonged abnormal erection). ... 

According to the manufacturers of sildenafil, priapism (painful prolonged abnormal erection) associated with its use is rare, and there appear to be no other reports about an interaction between sildenafil and dihydrocodeine. Excessively prolonged erections can have serious consequences and may need urgent treatment. Therefore, the authors suggest it would now be prudent to warn patients about this possible (though remote) problem if opioids are being used, and advise them to contact the prescrib-er if priapism occurs. ... 

Veno-occlusive priapism presents with a painful erection, which can already have been there for days. Prolonged veno-occlusive priapism results in fibrosis of the penis and a loss of the ability to achieve an erection. Significant changes at the cellular level are noted within 24 h in veno-occlusive priapism, whereas arterial priapism is not associated with fibrotic change. Veno-occlusive priapism most commonly is idiopathic, although there is a long list of other causes which include leukemia and multiple myeloma, sickle cell disease, thalassemia, spinal cord injury, spinal anesthesia and drugs. 

As described in Chapter 9, priapism is an uncommon medical condition defined as persistent tumescence or erection not associated with sexual desire or stimulation (Pautler and Brock 2001). Different pathophysiologies have been described. Low-flow or ischemic priapism is characterized by complete painful erection secondary to inadequate venous outflow leading to hypoxia, acidosis and pain (Lue et al. 1986 Pautler and Brock 2001). High-flow priapism is usually associated with penile or perineal blunt trauma and cavernosal artery tear (Pautler and Brock 2001). Patients... 

Clinical features Priapism is defined as a painful and unwanted erection, which is classified as stuttering (less than 3 hours), often multiple prolonged (more than 3 hours). Up to 89% of males with SCD will have at least one episode by age 20. The mean age of the initial episode is 12 years of age. Repeated episodes can cause fibrosis and impotence. 

Priapism is an abnormal, painful, and persistent erection, not related to sexual arousal, which can be caused by a variety of conditions (e.g., neurological, hematological, local trauma, and scorpion or black widow spider bites). Its occurrence also has been associated with various drugs, including the following ... 

Intracavernosal injection or urethral suppository therapy with alprostadil (PGE1) is a second-line treatment for erectile dysfunction. Doses of 2.5-25 meg are used. Penile pain is a frequent side effect, which may be related to the algesic effects of PGE derivatives however, only a few patients discontinue the use because of pain. Prolonged erection and priapism are side effects that occur in less than 4% of patients and are minimized by careful titration to the minimal effective dose. When given by injection, alprostadil may be used as monotherapy or in combination with either papaverine or phentolamine. 

Intracavernosal alprostadil was effective and well tolerated in the treatment of erectile dysfunction, according to the results of a 6-month study (funded by Pharmacia Upjohn) in 848 men (mean age 52 years) with at least a 4-month history of erectile dysfunction (12). This is provided that the individual dose is established by titration and patients receive training in injection techniques and periodic supervision during treatment. An initial dose was established for each patient and the patients then administered the alprostadil themselves at home. Of 727 evaluable patients, 682 (94%) had at least one erectile response after the injection of alprostadil, and 88% of injections lead to a satisfactory sexual response. The most commonly reported adverse event was penile pain, reported by 44% of patients, but only after 8% of injections. In just over half of the patients who had penile pain, the condition was reported as mild. Prolonged erection, penile fibrosis, and priapism occurred in 8,4, and 0.9% of patients respectively. Treatment was withdrawn because of medical events in 4% of patients, and drug-related events accounted for treatment withdrawal in 2% of patients. 

A man developed a persistent painful penile erection 12 hours after the administration of a 12% fat emulsion (120). This was thought to have been caused by venous thrombosis in the corpora cavernosa, and the priapism was immediately relieved by bilateral corpora cavernosa spongiosa shunts, although the patient remained impotent. 

One month after transplantation, a 19-year-old man who was taking tacrolimus, azathioprine, and prednisone, developed nausea and vomiting. He reported a 2-week history of painful spontaneous penile erections lasting 2-3 minutes and had had no previous episodes of priapism. An episode of spontaneous erection was confirmed during a medical examination that found no physical abnormalities. The tacrolimus blood concentration was 28 ng/ml. The digestive symptoms and priapism resolved after the tacrolimus concentration had fallen. Sickle cell disease was ruled out. 

Decreased libido impotence Impotence decreased libido Painful nocturnal erections Priapism, especially with neurological disorders... 

A journalist s account, based purely on anecdotal reports, claims that the illicit use of sildenafil with ecstasy (MDMA, methylenedioxymethamfet-amine) causes hammerheading because of the pounding headache and the prolonged and painful penile erections that require emergency medical treatment. The report does not say how much of each of these drugs is taken to produce these adverse effects. The outeome ean clearly be unpleasant, painful and, the priapism, potentially serious. 

Rare but important events agitation, allergic reactions, alopecia, anxiety, bradycardia/tachycardia, extrapyramidal symptoms, hepatitis, priapism (i.e. prolonged or constant penile erection that can be painful), rash, seizure, speech impairment, urinary retention, risk of suicidal ideations or attempts. 

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