Priapism with Sertraline-Risperidone Combination

Priapism is a rare side-effect of certain psychotropic drugs, especially antipsychotics and trazodone [1] [3] [4]. The mechanism of drug-induced priapism is thought to be related to alpha-1 adrenergic blockade [1].

SSRIs are well known to cause various kinds of sexual dysfunction in men and women, such as decreased libido, arousal difficulties including erectile dysfunction, orgasm delay, and anorgasmia. SSRIs as a group have little affinity for alpha-1 adrenergic receptors and thus rarely cause priapism. The SSRI sertraline has higher affinity for alpha-1 adrenergic receptors than other SSRIs [2]. Only few cases of SSRI associated priapism have been reported in the literature. A MEDLINE search with the terms “priapism and sertraline” or “priapism and risperidone” resulted in descriptions of 14 cases of priapism occurring during treatment with risperidone, two cases during treatment with sertraline, one case with a risperidone-citalopram combination [5], and another case with a risperidone-paroxetine combination [6].

I report here on a case of priapism in a patient taking sertraline 50 mg/day and risperidone 3 mg/day.

References

• 1 Compton MT, Miller AH. Priapism associated with conventional and atypical antipsychotic medications: a review.  J Clin Psychiatry. 2001;  62 362-366
• 2 Freudenreich O. Exacerbation of idiopathic priapism with risperidone-citalopram combination.  J Clin Psychiatry. 2002;  63 249-250
• 3 Raja M, Azzoni A. Tardive priapism associated with clozapine. A case report.  Pharmacopsychiatry. 2006;  39 199-200
• 4 Richelson E. Synaptic effects of antidepressants.  J Clin Psychopharmacol. 1996;  16 ((3 Suppl 2)) 1-9
• 5 Warner MD, Dorn MR, Peabody CA. Survey of the usefulness of trazodone in patients with PTSD with insomnia or nightmares.  Pharmacopsychiatry. 2001;  34 128-131
• 6 Yang P, Tsai JH. Occurrence of priapism with risperidone-paroxetine combination in an autistic child.  J Child Adolesc Psychopharmacol. 2004;  14 342-343

Correspondence