Sage Templeton, BA
Medical Student
University of New Mexico School of Medicine
Albuquerque, New Mexico, United States
Lanah Koh, MD
Doctor
University of New Mexico
Albuquerque, New Mexico, United States
William Daprano, MD
Medical Resident
University of New Mexico PM&R
Albuquerque, New Mexico, United States
Austin Davis, MD
Assistant Professor, Traumatic Brain Injury
University of New Mexico
Albuquerque, New Mexico, United States
Trazodone-induced acute ischemic priapism.
Case Description:
A 49-year-old male presented to acute care hospital after motorcycle accident with mild traumatic brain injury and traumatic left transtibial amputation prompting physiatry consult. The consult team recommended trazodone 50 mg at bedtime which was increased to 100 mg after four days due to persistent sleep disturbances. Eight days after trazodone initiation, the patient experienced a painful, 48-hour erection but delayed reporting due to embarrassment. Cavernous arterial blood gas analysis confirmed ischemic priapism prompting corpora cavernosal aspiration and Winter’s shunt. Despite improvement in penile rigidity and pain, his erectile dysfunction was deemed irreversible.
Discussions:
Despite Ontario Neurotrauma Guideline recommendations and wide usage at low doses in rehabilitation settings for insomnia, trazodone’s associated risk of priapism is often not discussed with patients and families. In this case, the physiatry consult team did not inform the patient or family, leading to a delay in symptom reporting.
Conclusions:
Although trazodone-induced priapism is rare, it is a surgical emergency that can quickly progress to permanent erectile dysfunction or even penile amputation if not promptly recognized and managed. Delays in intervention resulting from a lack of patient and family awareness can thus significantly affect outcomes. Given the potentially debilitating sequelae, this case underscores the need for improved communication with patients and families about adverse effects of trazodone.
