Trazodone priapism with

Trazodone routinely causes sedation, which is why it is used far more often as an adjunct with other antidepressants for sleep than as a primary agent for the treatment of depression. Priapism is a rare but serious adverse effect in males who take trazodone. In addition, orthostatic hypotension and dizziness are more common with trazodone than with nefazodone because the latter agent has a weaker effect at a-adrenergic receptors and also has a balancing of adrenergic effects owing... 

Priapism occurs rarely with trazodone use (1 in 6,000 male patients). Surgical intervention may be required, and impotence may result. 

Histamine blockade is responsible for the sedation associated with trazodone. Furthermore, priapism and orthostatic hypotension are mediated by a-adrenergic antagonism. There have been over 200 case reports of priapism (Thompson et ah, 1990). Prevalence estimates of priapism suggest that 1/6000 men treated with trazodone will be affected. Other side effects include dry mouth, nausea, and vomiting. Because of trazodone s wide therapeutic window, it is relatively safe in overdosage. There are case reports of patients surviving intentional overdoses of up to 9 (Gamble and Peterson,... 

Trazodone is an older antidepressant that is associated with significant sedation. Currently, trazodone is not recommended as a first-line antidepressant because of an increased risk of orthostatic hypotension, arrhythmias, and priapism. Also, compared with other available antidepressants, trazodone does not offer an advantage in terms of therapeutic efficacy. However, trazodone may be useful in patients with insomnia. It is currently common practice to use low doses of trazodone (e.g., 50-100 mg) to assist with initial insomnia while starting treatment with one of the newer antidepressants to address the underlying depression. If this strategy is used, we recommend tapering the trazodone dose and discontinuing treatment with trazodone after 4—6 weeks. 

Clitoral priapism has been reported with other antidepressants, including SSRIs both alone and in combination with trazodone. In men, trazodone rather than nefazodone is occasionally associated with priapism (SEDA-21,14). 

Myrick H, Markowitz JS, Henderson S. Priapism following trazodone overdose with cocaine use. Ann Clin Psychiatry 1998 10(2) 81-3. 

Adverse reactions with administration of bupropion include citation, dry mouth, insomnia, headache, nausea, constipation, anorexia, weight loss, and seizures. Fluoxetine administration may result in headache, activation of mania or hypomania, insomnia, anxiety, nervousness, nausea, vomiting, and sexual dysfunction. Trazodone administration may cause the following adverse reactions drowsiness, skin disorders, anger, hostility, anemia, priapism, nausea, and vomiting. Additional... 

Trazodone, 25 to 100 mg, is often used for insomnia induced by selective serotonin reuptake inhibitors or bupropion. Side effects include serotonin syndrome (when used with other serotonergic drugs), oversedation, a-adrenergic blockade, dizziness, and rarely priapism. 

These include trazodone and a derivative of its metabolite nefazodone, both of which are strongly sedative, an effect which has been attributed to their potent alpha-1 receptor antagonism rather than to any antihistaminic effects. A main advantage of these drugs in the treatment of depression is that they appear to improve the sleep profile of the depressed patient. Their antidepressant activity is associated with their weak 5-HT reuptake inhibition and also a weak alpha-2 antagonism. However, unlike most of the second-generation antidepressants, neither drug is effective in the treatment of severely depressed patients. Furthermore, there is some evidence that trazodone can cause arrythmias, and priapism, in elderly patients. 

Trazodone may cause priapism and enhance libido, and it prolongs nocturnal erections. This drug has been used both orally and by intracavemosal injection. It can be used alone or in combination with yohimbine. Overall, trazodone has not been as effective in treating ED as other available agents. However, it may be an option for selected patients, particularly those with performance anxiety or low libido. 

It is difficult to justify, therefore, any use of trazodone in boys, adolescent males, or young men, especially given its relatively limited usefulness as an antidepressant or even a sedative. Even in girls its use is questionable. Nefazodone would appear to be a far better alternative, especially in that it has no recognized sexual side effects, is well tolerated once the patient adapts to the sedative effect, and is not associated with priapism. That is, risks do not include a known increase in priapism above the background incidence (Thompson et ah, 1990 Feiger et ah, 1996 Pecknold and Langer, 1996). 

Trazodone is the only antidepressant that has been associated with priapism, which may be irreversible and require surgical intervention. 

In contrast to decreased libido seen with SSRIs and venlafaxine, concerns about priapism invariably arise when trazodone is discussed. This adverse effect is rare, occurring in only 1 of 6,000 treated male patients (456, 457). If the patient is informed of this possibility and discontinues the drug promptly, priapism usually resolves without further intervention. Although earlier persistent cases were treated surgically, this approach carries a 50% chance of permanent impotence pharmacological intervention via direct injections into the cavernous bulbosa is preferable ( 458, 459). Using this approach, the chance of permanent impotence is low and depends on the duration of symptoms before treatment (460). This latter fact is another reason to fully inform the male patient on trazodone, so that early detection and intervention can be implemented. 

SERT. However, trazodone has rarely been associated with inducing priapism. The effects of both nefazodone and trazodone since tx-blocking agents result in a dose-related orthostatic hypotension in some patients. Nefazodone has been associated with hepatotoxicity, including rare fatalities and cases of fulminant hepatic failure requiring transplantation. The rate of serious hepatoxicity with nefazodone has been estimated at 1 in 250,000 to 1 in 300,000 patient-years of nefazodone treatment. 

Priapism is occasionally associated with the use of psychotropic drugs, such as trazodone, that are oq-adreno-ceptor antagonists. It has also been reported in a man taking sertraline (17). 

Identical twin brothers, aged 37 years, had both suffered from bipolar disorder since their early twenties and had been treated with chlorpromazine, haloperidol, lithium, and carbamazepine before developing priapism. One of them developed priapism after taking trazodone 400 mg/day, and in the 2 years after the initial episode he suffered recurrent painless erections. Initially they occurred daily and lasted 4-5 hours. During a relapse of mania at age 37, he was given oral zuclopenthixol 40 mg/day. On the tenth day he presented with priapism of 4 days duration, which persisted despite zuclopenthixol withdrawal, needle aspiration, and phenylephrine instillation, but subsided 2 weeks later with conservative management. The... 

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. 

A rare but potentially serious adverse effect of trazodone is priapism, which is reported to occur in approximately 1 in 6000 male patients. Some cases have required surgical intervention (1 in 23,000), and permanent impotence may result. There have been no reports of priapism associated with nefazodone use in men, but there is a published case report of nefazodone-induced clitoral priapism. ... 

Aranoff GM. Trazodone associated with priapism. Lancet 1984 1 856. 

The most severe reactions reported with overdose of trazodone alone have been priapism, respiratory arrest, seizures, and ECG changes. 

Insomnia caused by major psychiatric illnesses often responds to specific pharmacological treatment for that illness. In major depressive episodes with insomnia, for example, the selective serotonin reuptake inhibitors, which may cause insomnia as a side effect, usually will result in improved sleep because they treat the depressive syndrome. In patients whose depression is responding to the serotonin reuptake inhibitor but who have persistent insomnia as a side effect of the medication, judicious use of evening trazodone may improve sleep, as well as augment the antidepressant effect of the reuptake inhibitor. However, the patient should be monitored for priapism, orthostatic hypotension, and arrhythmias. 

Trazodone associated with cardiac arrhythmias and priapism... 

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