Chlorpromazine induced priapism from a single dose: an unusual complication of antipsychotic agent

Abstract

Priapism is considered as an unusual andrological emergency that requires urgent intervention. It is defined as prolonged penile erection (usually painful) for more than 4 hours not related to sexual excitation or stimulation. Several causes have been attributed to cause such condition including the use of psychotropic drugs as chlorpromazine. Only few case reports in literature have recorded priapism as a complication of administration of chlorpromazine, however most of them were due to overdose or prolonged administration for prolonged period or as an interaction with other drugs. Here, in this case report is about a 23 years old male presented to the emergency department with neglected priapism after administration of a single dose of chlorpromazine.

Chlorpromazine-Induced Priapism in A 22-Year-Old Undergraduate Managed Conservatively in A Psychiatric Setting

“…Available literature shows only one case of priapism was reported after self-administered chlorpromazine via the trans-urethral route [29]. In addition, only a few case reports have discussed priapism occurring after a short-term administration of chlorpromazine, as our case report, which occurred after a single low-dose intramuscular administration of the drug [14]. The complexities in the management of priapism are because it has remained controversial and continued to pose challenges to urologists.…”

“…These signals for possible risk for priapism were present for chlorpromazine, quetiapine, risperidone, ziprasidone, and aripiprazole [2]. Chlorpromazine, which is our drug of concern in this report, is a conventional antipsychotic, that is commonly used for its sedative properties, in patients with abnormal behaviors, amongst other uses [14]. The mechanism causing priapism, associated with the use of chlorpromazine, includes peripheral alpha-1 blockade, and its central serotonin-like actions [15].…”

“…Antipsychotic drugs including, chlorpromazine, thioridazine, and risperidone have been reported as a causative factor of priapism [28]. Concerning priapism induced by chlorpromazine, just a few reported cases have been mentioned in literature and most of them were due to overdose, long-term therapy of psychiatric illness or interaction as well as Combined use of antipsychotics, psychostimulants, antidepressants, and mood stabilizers such as Risperidone, quetiapine, methylphenidate and Trazadone [14]. In this patient, administration of the Chlorpromazine was via the intramuscular route, administered by the nursing staff.…”

Risperidone-induced Priapism: A Rare Case Report

“…Considering the fact of least likely to cause priapism, olanzapine was chosen. 3,5 Starting at 2.5 mg per day and gradually increasing by 2.5 mg every 4th day, 15 mg per day was reached along with trihexyphenidyl 2 mg once daily. On an as needed basis, diazepam was used.…”

“…Among all priapism caused by medications, 15-26% are due to antipsychotics. 4,5 The responsible mechanism is α-1-adrenoreceptors-induced statis of intracavernosal blood. 6,7 A patient who had priapism from risperidone is reported here along with the how he resolved from this adverse effect is presented.…”