Priapism associated with zuclopenthixol treatment: A case report

Background: Priapism is pathologically prolonged and painful penis erection, usually without sexual desire or stimulation. Priapism is classified as veno occlusive low şow (ischemic) and arterial high şow (non ischemic). The low şow–ischemic type is the most common type of priapism and if it is untreated, leads to irreversible ischemic cavernosal tissue changes. The causes include generally certain medications, although the mechanism for drug-induced priapism is unknown (1-4). Here we discuss, in light of the literature, a 62-year-old- male paranoid schizophrenic patient, who had been treated with oral zuclopenthixol since 1995 and developed an acute and painful erection.

Case: It was revealed that the patient, who presented with priapism, that hadcontinued for a week, took zuclopenthixol 20 mg a day for 2 days prior to the veno occlusive priapism. After emergency urological treatment, the psychiatric examination revealed paranoid psychosis. Zuclopenthixol was stopped and risperidone 6 mg/day and biperiden 4 mg/day were prescribed. A week later he was discharged from hospital.

Discussion: In many cases it has been reported that psychotropic drugs may cause priapism. Some of them are trazadone, chlorpromazine, haloperidol, zuclopenthixol, olanzapine, ziprasidone, and clozapine (3). Although the mechanism of priapism associated with antipsychotics is not clear, it is thought to be related to blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis (3). Similarly, the capacity of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on alpha-1 adrenergic receptors (1,3). Therefore it is important that clinicians must take notice of side effects of antipsychotics, including rarely seen ones.

References:
1. J Salado, A Blazquez, R Diaz-Simon, F Lopez-Munoz, C Alamo and GG Rubio Priapism associated with zuclopenthixol: Ann Pharmacother June 1, 2002 vol. 36 no. 6 1016-1018
2. Brichart N, DElavierre D, Peneau M, Ybrauhim H, Mallek A. Priapism induced with antipsychotic medications: a series of four patients. Prog.Urol. 2008 Nov; 18 (10): 699-73.Epub 2008 Jun 10.
3. Sood S, James W and Bailon MJ. Priapism associated with atypical antipsychotic medications. a review. Int Clin Psychopharmacol 2008; 23: 9-17
4. Şükrü Kartalcy, Işıl Göçcesöz Gül, Rıfat Karlıdağ, Birgül Elbozan Cumurcu Recurrent priapism during quetiapine treatment case report; Bulletin of Clinical Psychopharmacology, Vol: 20, N.: 4, 2010 327-328 Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S167-8