Medications associated with priapism
| Class . | Drugs . | Potential mechanism . |
|---|---|---|
| Antihistamine | Hydroxyzine | Used as an antianxiety drug because of its effect on serotonin. May cause priapism due to interference with α-adrenergic property. |
| Anesthetic | Propofol | Potential mechanisms include vasodilatation, inhibition of sympathetic response, and enhancing smooth muscle relaxation effect of nitric oxide. |
| Antihypertensives | Hydralazine, guanethidine | Likely through vasodilation. |
| Anticonvulsants | Sodium valproate, pregabalin | Possibly induces priapism through increasing parasympathetic tone or alteration of phosphodiesterase expression. |
| α-Adrenergic blockers | Tamsulosin, prazosin, etc | Blocking α-adrenergic receptors will enhance the parasympathetic effect on penile smooth muscles. |
| Anticoagulants | Warfarin, heparin | Warfarin can cause paradoxical thrombosis, especially in individuals with protein C deficiency. Heparin may cause priapism through activation of platelets by antibodies, leading to thrombosis within penile blood vessels. |
| Sex hormones | Testosterone, gonadotrophin-releasing hormone | Upregulation of nitric oxide synthase. |
| Antipsychotics | Chlorpromazine, haloperidol, olanzapine, zuclopenthixol, lithium, etc | Proposed to cause priapism via α-adrenergic inhibition. |
| Antidepressants | Citalopram, fluoxetine, trazodone | Causes priapism via interference with sympathetic control. |
| Vasodilators | Papaverine, drotaverine, prostaglandin E, alprostadil, phentolamine | Papaverine is a nonselective inhibitor of phosphodiesterase. |
| Medications for attention-deficit disorders | Methylphenidate, atomoxetine | Acts via blocking norepinephrine and dopamine reuptake channel. |
| Recreational drugs | Alcohol, marijuana, cocaine | Cannabis may cause priapism by blocking sympathetic response or activating platelets, leading to thrombosis. Cocaine may cause depletion of norepinephrine from nerve terminals. |
| Class . | Drugs . | Potential mechanism . |
|---|---|---|
| Antihistamine | Hydroxyzine | Used as an antianxiety drug because of its effect on serotonin. May cause priapism due to interference with α-adrenergic property. |
| Anesthetic | Propofol | Potential mechanisms include vasodilatation, inhibition of sympathetic response, and enhancing smooth muscle relaxation effect of nitric oxide. |
| Antihypertensives | Hydralazine, guanethidine | Likely through vasodilation. |
| Anticonvulsants | Sodium valproate, pregabalin | Possibly induces priapism through increasing parasympathetic tone or alteration of phosphodiesterase expression. |
| α-Adrenergic blockers | Tamsulosin, prazosin, etc | Blocking α-adrenergic receptors will enhance the parasympathetic effect on penile smooth muscles. |
| Anticoagulants | Warfarin, heparin | Warfarin can cause paradoxical thrombosis, especially in individuals with protein C deficiency. Heparin may cause priapism through activation of platelets by antibodies, leading to thrombosis within penile blood vessels. |
| Sex hormones | Testosterone, gonadotrophin-releasing hormone | Upregulation of nitric oxide synthase. |
| Antipsychotics | Chlorpromazine, haloperidol, olanzapine, zuclopenthixol, lithium, etc | Proposed to cause priapism via α-adrenergic inhibition. |
| Antidepressants | Citalopram, fluoxetine, trazodone | Causes priapism via interference with sympathetic control. |
| Vasodilators | Papaverine, drotaverine, prostaglandin E, alprostadil, phentolamine | Papaverine is a nonselective inhibitor of phosphodiesterase. |
| Medications for attention-deficit disorders | Methylphenidate, atomoxetine | Acts via blocking norepinephrine and dopamine reuptake channel. |
| Recreational drugs | Alcohol, marijuana, cocaine | Cannabis may cause priapism by blocking sympathetic response or activating platelets, leading to thrombosis. Cocaine may cause depletion of norepinephrine from nerve terminals. |
(Reproduced from Idris et al.,23 with a slight modification, with the permission of the Blood Advances.)