Priapism Associated With the Use of Stimulant Medications and Atomoxetine for Attention-Deficit/Hyperactivity Disorder in Children

Abstract

Priapism has been associated with stimulants, amphetamines, and atomoxetine use for ADHD in children. Providers and health care practitioners should educate male patients prescribed these ADHD medications as well as caregivers regarding the signs, symptoms, and complications with priapism. Discontinuation and evaluation of the medication is warranted if this adverse drug reaction occurs. Depending on the priapism subtype, other products may be initiated or medications not associated with priapism may be utilized.

Advances in the understanding of priapism

“…Etiologies of ischemic priapism include malignancy, medications such as phosphodiesterase-5 inhibitors (7), trazadone (8) and amphetamines (9), spinal cord injury (10), and hematologic conditions, such as sickle cell disease and glucose-6-phosphate deficiency ( Figure 1 ) (11,12). Most often ischemic priapism is idiopathic.…”

Pediatric Priapism Secondary to Psychotherapeutic Medications

“…5 It is surprising that atomoxetine alone could cause priapism because it selectively binds the presynaptic noradrenaline transporter as a reuptake inhibitor, and noradrenaline contributes to detumescence. 13,14 As reported by Goetz, Eli Lilly reports several postmarketing cases of priapism in children and adults on atomoxetine. 4 In addition, the Food and Drug Administration has acknowledged multiple cases of priapism in children taking atomoxetine and reports that priapism may be more common with atomoxetine than with the more often associated methylphenidate.…”

“…4 In addition, the Food and Drug Administration has acknowledged multiple cases of priapism in children taking atomoxetine and reports that priapism may be more common with atomoxetine than with the more often associated methylphenidate. 13,15 Biochemical changes in peripubertal males could alter the priapism risk, which could explain why priapism can occur in children on stable medication doses.…”

From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate

“…Cases of a prepubertal child and a 14-year-old male who developed priapism after therapy with MPD have been reported in literature [ 88 , 89 ]. It is recommended that healthcare professionals should inform male patients about the symptoms and signs of priapism and emphasize the necessity for immediate treatment, since younger males may not recognize the problem or be too embarrassed to tell anyone if it happens [ 90 ].…”