A Review of Priapism Associated with Quetiapine

Priapism is defined as the painful and prolonged penile erection in the absence of any sexual desire and arousal. It is considered as a urologic emergency and needs immediate attention as it can lead to sexual dysfunction. It has various etiologies, including idiopathic, medicinal, and medical ones. It is divided into two types: low-flow and high-flow. Medications, including quetiapine cause low-flow priapism. The aim of this study was to review the relationship between quetiapine use and priapism.
In most reports of drug-induced priapism, there was no relationship between the dose and duration of drug use. But a relationship was found between quetiapine use and priapism, due to overdose, continuous or single dose, and idiosyncratic reaction. Other than quetiapine, some other antipsychotics could also cause periapism. Recurrent priapism could happen in people with history of drug-induced priapism if the dug is continued. Priapism is associated with the mechanism of alpha1 adrenergic receptor blocking in the penis corpus cavernosum. The antipsychotics affinity to blocking this receptor are different and in quetiapine there is a moderate tendency. Co-administration of CYP450 inhibitors with quetiapine increases some complications such as priapism, and vice versa the inducers of these enzymes, such as smoking, alongside quetiapine decrease this complication by reducing serum levels of the drug. Awareness about the possibility of complications of quetiapine by physicians lead to prompt diagnosis and treatment, thereby preventing other associated complications.