Dose Dependent Priapism Induced by Amisulpride Use

Abstract

To the Editor: Priapism, an uncommon urological emergency, is a pathological, prolonged and painful penile erection, usually unassociated with sexual desire or intercourse 1 . Drug-induced priapism comprises about 30% of the cases and it’s estimated 50% of them occurred with antipsychotic agents 2 . Although typical antipsychotics are often associated with priapism, there are some case reports with clozapine, risperidone, olanzapine, quetiapine, and aripiprazole 3 . Here, we present a case report of dose dependent priapism due to 800 mg/day of amisulpiride. 26 year-old- male patient was admitted to our inpatient clinic with disorganized speech and behavior, and persecutory delusions and was diagnosed as schizophrenia . He was on amisulpiride 200 mg/day treatment for one year. His previous treatments were flupentixol depot, olanzapine, risperidone, and chlorpromazine. He was switched to amisulpiride 1 year ago due to side effect of weight gain. The patient’s physical and neurological examinations, urine-blood drug and substance screening, and labaratory tests were normal. Increasing the dose of Amisulpride 200/ mg per week, a dose of 800 mg/day was attained. In the first day of using 800 mg amisulpride, patient reported to have involuntary, painful erection which lasted about 6 hours. Urology consultation was requested and the urology specialist ruled out other causes and reported that priapism was probably due to amisulpride use. Urology consultant did not mention any other medical condition for priapism. So amisulpride treatment was stopped. We did not observe priapism for 3 days after stopping medication. As we knew that previously, patient was clinically stable with 600 mg/day of amisulpride, we decided to initate amisulpride again. We started at 400 mg/ day dose and increased to 600 mg/day after 3 days. We did not observe priapism with 600 mg/day. This time, we decided not to increase Amisulpride dose to 800 mg/day.