March 24, 2023

In this video we discuss the relationship between Trazodone usage and priapism, how common it is, how it happens, and common treatment methods.

Hello my name is russell i’m a medical student going into psychiatry and today we’ll we will be talking about the relationship between trazodone and priapism this is something that keeps a lot of men from trying this drug for insomnia so i’m here to just tell you what i know about it we’ll look at some of the data and what to do if it happens so just a little

Overview trazadone is an antidepressant that was released i think in the 80s but it never really caught on because at antidepressant doses it’s so sedating so when you take like a third to a sixth of what would be a therapeutic dose for mood or anxiety you get great sleep instead so one of the scariest side-effects but rare but also dramatic side effects of

Trazadone is priapism priapism is an inappropriately long erection that is not relieved by ejaculation so why does trazadone cause priapism in a small amount of people this is thought to be mediated through alpha-adrenergic receptors and the blockade at these receptors that this drug does so alpha-adrenergic receptors these help control the the width and the

Relaxation or dilation of blood vessels including in the penis and if you get too much of a blockade here this can when you get an erection it will trap the blood in your penis and it can have devastating consequences so priapism if not treated properly oftentimes goes away but if it doesn’t and it’s over 24 hours or so this can be devastating i’ve seen a case

Report of a penile amputation after trazadone induced priapism this is of course very rare this is just a case report but it’s scary so let’s get into this so the the official numbers on so when you look at how common this is i see anywhere from one in a thousand to one in ten thousand which isn’t super isn’t super helpful if you just go to the wikipedia page

For trazodone they cite a paper that says it happens in about one in 6,000 people regardless this is a very rare side effect but scary so a couple things about priapism from trazodone this usually occurs in the first month or two of treatment it’s also been shown to occur at small doses but this i don’t know i’m not super convinced about that because you know most

People take low doses of trazadone because it’s four because it’s friends omnia so it could be that higher doses is even worse i don’t know there’s not enough data to really go into that but it’s usually doses of under 150 where this occurs and so priapism there’s two different kinds there’s high flow and there’s low flow priapism high flow is usually from trauma

Low fro low flow is the scary type that priapism causes this is when blood gets trapped in the corpora cavernosa of your penis and so what do you do with this occurs in your situation so if you have a if you have an erection that lasts over two hours i would personally go to the er if if that were happening to me some recommendations say if it’s lasted over four

Hours so there’s a couple things that you can do though some websites actually recommend that you take pseudoephedrine before going to the emergency room like waiting an hour and then if it hasn’t cleared up go in so because trazadone causes priapism through a blockade of alpha adrenergic receptors it would make sense that drugs that actually activate or agonize

Alpha receptors might actually help pseudoephedrine there’s some evidence that that probably helps that’s straight up just sudafed so that’s not by prescription but it is behind the counter now it’s not over the counter you have to go and talk to a pharmacist since sudafed is used in making meth nowadays but let’s say you’ve waited a couple hours it’s not getting

Better what do medical professionals suggest that you do so generally the recommendation is to go to the nearest hospital this is an emergency the urologist on call will be called immediately and they’ll try various things to try to secure your priapism so one of the first things they’ll do is probably one of the first things they’ll probably do is give you either

Pseudoephedrine or another alpha agonist phenol ephedrine or phenol efrain sorry sometimes this is a shot sometimes what they’ll do actually is they’ll put a huge needle in your penis and aspirate or suck out all of the blood sometimes this is also used in conjunction with saline aspiration which just means that they they clear out they clean out your penis with

Sterile saltwater sometimes they’ll inject these alpha drugs directly into the penis if it’s not an intramuscular shot so let’s say they’ve tried medications they’ve tried sucking out the blood to relieve the pressure and that doesn’t work the next step that usually happens is a shunt the most common type of shunt for priapism is a winter shunt and this is when i

Heat a large biopsy needle is inserted through the glans also the tip of the penis into the corpora cavernosa to try to alleviate the blockade that way so if that doesn’t work if a shunt doesn’t work you know they’ll try whatever they can if if you’ve tried all of these things and it doesn’t work yet there is a chance that you will have permanent damage to your

Penis if if if your penis doesn’t get new blood for long enough you’ll get a ski mia which just means there’s not enough blood that issue and your penis will start dying and this can be devastating this will cause fibrosis inside of your penis in the corpora cavernosa and this can make it difficult or impossible to get an erection so what would you do if that

Were to happen the options then would be penile penile prosthesis so there’s two main types you can either get a type of prosthesis where you can pump up your penis with like a pump type thing sometimes located actually in one of your in your scrotum and then sometimes it’s it’s this thing that is surgically placed around your penis that you can kind of just like

Kind of just like i don’t know how to describe this it’s like a little joint that locks into place that you can so you can get kind of an erection for sex so after saying all this it’s important to note that priapism from trazadone is very rare a large percentage of people that have priapism are able to be treated or it goes away most people don’t end up having

Permanent penis damage but it’s something that a lot of people worry about i’ve seen this in medical school all the time where there’s been various male patients that had heard about priapism for trazadone and they they don’t want to try it because of that when it could have been an amazing drug for their sleep and it could have helped their depression if they’re

Able to sleep more so this is information only none of this is medical advice i’m not advocating or not advocating the use of trazadone talk to your doctor before starting any medications if you have any comments leave them below thank you

Transcribed from video
Trazodone and Priapism: Everything You Want To Know By Simple Psychiatry MD