Case reportTadalafil-associated priapism
Section snippets
Case report
A 46-year-old white man presented to the Emergency Department in mild distress, complaining of a rigid, painful erection for approximately 36 hours. He denied any desire or interest in sexual stimulation. Two evenings earlier, an acquaintance had provided him with an unknown dose of tadalafil, to which he was naïve. After completing intercourse with his wife, he fell asleep, only to awaken the next morning with a painful erection. Hoping for spontaneous resolution, he waited an additional 24
Comment
Phosphodiesterase-5 inhibitors have revolutionized the medical management of erectile dysfunction. Despite the warnings of inappropriately prolonged erection listed on popular advertisements, the risk of priapism associated with these medications is largely unknown. Tadalafil-related priapism is thought to be exceedingly rare. A postmarketing safety surveillance study by Eli Lilly reported the risk of tadalafil-associated priapism as less than 1 in 10,000.1 Only a handful of case reports of
References (7)
- et al.
The efficacy and safety of tadalafil in United States and Puerto Rican men with erectile dysfunction
J Urol
(2004) - et al.
Sildenafil citrate-associated priapism
Urology
(2000) - et al.
Efficacy of shunt surgery for refractory low flow priapisma report on the incidence of failed detumescence and erectile dysfunction
J Urol
(2003)
Cited by (24)
Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction
2018, Sexual Medicine ReviewsCitation Excerpt :Of note, 27% of men with an incidence of priapism in the latter analysis had been using concomitant medications that might have contributed to the priapic episodes.56 Few other individual case reports of PDE5I-induced priapism have been published, some of which were confounded by the concomitant use of opiates and intracavernosal injections.66–70 Recently, emerging data have even suggested a potential role for daily PDE5I therapy for the suppression of priapic episodes in men with stuttering priapism, a condition in which PDE5 dysregulation is believed to be contributory.71
Guidelines for erectile dysfunction. Colombian Urological Society
2015, Urologia ColombianaErectile dysfunction
2013, The LancetCitation Excerpt :Tadalafil can cause myalgia and pain at different body sites (table 3). PDE5-I-related priapism has been reported in a few case reports.114,115 A direct link between PDE5-Is and non-arteritic ischaemic optic neuropathy could not be established.116,117
Priapism and Sickle-Cell Anemia: Diagnosis and Nonsurgical Therapy
2012, Journal of Sexual MedicineCitation Excerpt :Tadalafil, 5 mg daily dosing, caused no priapism in a phase II clinical study of 281 men with history of lower urinary tract symptoms secondary to benign prostatic hyperplasia for 6 weeks followed by dosage escalation to 20 mg once daily for an additional 6 weeks [28]. From 1999 to 2007, there have been at least nine case‐based reports of oral phosphodiesterase type‐5 inhibitor dosing causing adult priapism and at least one pediatric case: Aoyagi [29], Sur [30], Kassim [31], Goldmeir [32], McMahon [33], Wilt [34], Gallati [35], Kumar [36], King [37], and Wills [38]. The majority of these cases detail histories of men with increased risk for priapism: SCD, spinal cord injury, men who used PDE5 inhibitor recreationally, men who used PDE5 inhibitor with ICI, men with history of penile trauma, men on psychotropic medications, or men abusing narcotics.
Priapism: Pathogenesis, epidemiology, and management
2010, Journal of Sexual MedicineCitation Excerpt :Tadalafil 5 mg daily dosing caused no priapism in a Phase II clinical study of 281 men with history of lower urinary tract symptoms secondary to benign prostatic hyperplasia for 6 weeks followed by dosage escalation to 20 mg once daily for 6 weeks [28]. From 1999 to 2007, there have been at least nine case-based reports of oral PDE5 inhibitor dosing and adult priapism and at least one pediatric case: Aoyagi [29]; Sur [30]; Kassim [31]; Goldmeier[32]; McMahon [33]; Wilt [34]; Galatti[35]; Kumar [36]; King [37]; Wills [38]. The majority of these cases detail histories of men with increased risk for priapism: SCD, spinal cord injury, men who used PDE5 inhibitor recreationally, men who used PDE5 inhibitor with ICI, men with history of penile trauma, men on psychotropic medications, or men abusing narcotics.
Treatment Options for Erectile Dysfunction
2007, Endocrinology and Metabolism Clinics of North AmericaCitation Excerpt :The FDA also reports that tadalafil induces somewhat less flushing (3%) than the other medications but may result in pain at different sites, most prominently the back (6%) and limbs (3%), and may result in general myalgia (3%). Priapism, or a pathologic erection that lasts longer than 4 hours despite lack of sexual stimulation, is uncommon, with isolated case reports in the literature [15,16]. PDE5is, as endothelial regulators, may be helpful in the prevention of recurrent priapic episodes (eg, in patients who have sickle cell disease or trait) [17].
- 1
H. Wessells is a lecturer for Pfizer.