Gabapentin in the management of the recurrent, refractory, idiopathic priapism

Abstract

Recurrent idiopathic priapism is a difficult problem to treat and a true emergency for the physicians, and often even invasive therapeutic interventions fail. We recently managed three men with refractory idiopathic priapism with oral gabapentin. They responded to treatment within 48 h. Two men continue not to experience prolonged erections while treated with lower doses of gabapentin for 16 and 24 months, respectively. The third, after a successful treatment for 6 months, stopped gabapentin and priapism recurred. He responded to treatment again and continues to be free of episodes for 9 months. Gabapentin may be a safe alternative for the management of refractory idiopathic priapism.

Medical management of ischemic stuttering priapism: a contemporary review of the literature

“…While the exact mechanism of action remains unknown, studies on rats have eluded to gabapentin's therapeutic effect in the management of priapism. 41,51,52 These studies demonstrated that gabapentin selectively inhibits calcium influx by inhibiting voltage-gated calcium channels, thereby attenuating synaptic transmission. 41 While the molecular targets of gabapentin remain unknown, inhibition of Medical management of ischemic stuttering priapism HR Levey et al 159 calcium efflux from smooth muscle cells in the corpora, with consequent inhibition of smooth muscle relaxation, serves to explain the therapeutic response seen in gabapentin users.…”

“…Gabapentin is a widely used analgesic and antiepileptic agent with anticonvulsant, antinociceptive and anxiolytic properties. 51 The rationale behind the treatment of priapism with gabapentin arose from reported sexual dysfunctions such as anorgasmia and decreased potency experienced by patients taking gabapentin. While the exact mechanism of action remains unknown, studies on rats have eluded to gabapentin's therapeutic effect in the management of priapism.…”

“…41 While the molecular targets of gabapentin remain unknown, inhibition of Medical management of ischemic stuttering priapism HR Levey et al 159 calcium efflux from smooth muscle cells in the corpora, with consequent inhibition of smooth muscle relaxation, serves to explain the therapeutic response seen in gabapentin users. 41 Another potential mechanism may be gabapentin's ability to reduce testosterone and follicle-stimulating hormone levels, as seen in a study by Daoud et al 53 In a small study by Perimenis et al, 51 three men with refractory priapism were treated with oral gabapentin. Each man responded to treatment within 48 h, and was sent home with varying doses of gabapentin to continue daily.…”

“…Upon re-initiation of treatment, his priapism was resolved for an additional 9 months while taking gabapentin. 51 While gabapentin appears to have a beneficial effect on the treatment of priapism, larger studies are needed to examine the reproducibility of these effects, its clinical efficacy, and mechanism of action.…”

Priapism: what to do?

“…Finally, gabapentin was successfully applied in three recurrent priapism patients. 42 Although the effect mechanism is not completely known, it is assumed that this event occurs by preventing the calcium efflux from flat muscle cells.…”