Priapism risperidone

Priapism Rare cases of priapism have been associated with risperidone, ziprasidone, quetiapine, aripiprazole, and olanzapine. 

In one case, priapism followed the use of first risperidone and then ziprasidone (534). 

A 22-year-old African-American with chronic undifferentiated schizophrenia developed priapism after taking risperidone 4 mg bd, clonazepam 0.5 mg bd, vitamin E 400 IU bd, and a multivitamin for over 6 months. He did not respond to subcutaneous terbuta-line 0.25 mg. Irrigation of the corpora with phenylephrine 200 p resulted in detumescence risperidone was withdrawn. A few months later he took ziprasidone 20 mg bd for 1 week, clonazepam 1 mg bd, and vitamin E 400 IU bd. The ziprasidone dosage was increased to 40 mg bd, but early the next morning he developed a firm erection with some discomfort that lasted about 2 hour and resolved when he urinated the next morning he had a similar erection that also lasted 2 hour and resolved. 

A 26-year-old man, who had previously taken a variety of psychotropic medications, including typical neuroleptic drugs and risperidone, without sexual adverse effects, took olanzapine 10 mg at bedtime (240). Soon after, he developed priapism 24 hours after withdrawal of olanzapine, the adverse effect disappeared. 

Priapism associated with risperidone occurred in a 19-year-old man who had taken 2 mg/day for 4 days (194). 

A 26-year-old man who had taken risperidone 3 mg/ day and sodium valproate 1500 mg/day for 1 year developed a persistent erection, dysuria, and urinary incontinence, which did not respond to irrigation of the corpora cavernosa on two occasions and required surgical treatment (196). Prolonged priapism also resulted in penile fibrosis, associated with a high risk of permanent erectile dysfunction. 

In one case priapism followed the use of first risperidone and then ziprasidone YET TO start HERE(197). In two other cases, presumed to be due to risperidone (198,199), penile irrigation with isotonic saline and phenylephrine injection resulted in detumescence. Risperidone has a high affinity for alpha-1 adrenoceptors, and alpha-1 blockade leads to direct arteriolar dilatation, which results in increased blood inflow and reduced outflow secondary to effacement and subsequent obstruction of emissary veins. 

Slauson SD, LoVecchio F. Risperidone-induced priapism with rechallenge. J Emerg Med 2004 27 88-9. 

Sirota P, Bogdanov I. Priapism associated with risperidone treatment. Int J Psychiatry Clin Pract 2000 4 237-9. 

Relan P, Gupta N, Mattoo S. A case of risperidone-induced priapism. J Clin Psychiatry 2003 64 482-3. 

Bourgeois JA, Mundh H. Priapism associated with risperidone a case report. J Clin Psychiatry 2003 64 218-9. 

Ankem MK, Ferlise VJ, Han KR, Gazi MA, Koppisch AR, Weiss RE. Risperidone-induced priapism. Scand J Urol Nephrol 2002 36(l) 91-2. 

Freudenreich O. Exacerbation of idiopathic priapism with risperidone-citalopram combination. J Clin Psychiatry 2002 63(3) 249-50. 

Worsening of side-effects such as slowness, stiffness and tremor, t blood levels. A single case report of priapism induced by a ginkgo-risperidone combination. Hyperthermia... 

Many of the other reactions (sedation, urinary retention, priapism) appear to be a result of additive adverse effects of the SSRIs and risperidone. The serotonin syndrome can result when two drugs with serotonin effects are given together, see Additive or synergistic interactions , (p.9). 

A case of a 21-year-old male with no prior history who developed priapism 3 days after being reintiated on oral risperidone is reported [266 ]. He was successfully treated with terbutaline and switched to asenapine with no recurrence. 

Another case of priapism in a 45-year-old male on risperidone and sodium valproate is reported [267 ]. Musculoskeletal A study of risperidone-associated prolactin elevation and markers of bone turnover found that prolactin levels significantly increased and N-telopeptide cross-links (markers of bone resorption) significantly decreased [268 ]. No differences were noted between men and women osteocalcin, N-telopeptide cross-links osteocalcin ratios, oes-tradiol and testosterone did not significantly change and there were no significant associations between risperidone dose and prolactin levels. 

Refai S, Nakama HH. A case of priapism associated with rapid increase in risperidone dose. Prim Care Companion CNS Disord 2012 14(5). 

Paklet L, Abe AM, Olajide D. Priapism associated with risperidone a case report, literature review and review of the South London and Maudsley hospital patients database. Ther Adv Psychopharmacol 2013 3(1) 3-13. 

---