Abstract
Introduction: Priapism is defined as a persistent and painful erection without sexual stimulation that lasts at least 4 hours. Although rare, it can be triggered by some factors such as hemoglobinopathies, paraneoplastic syndromes, and the use of recreational drugs and antipsychotics, with atypical and typical antipsychotics being responsible for half of the medication-induced priapisms. Objective: The present study aimed to record two clinical cases of priapism after the administration of a typical antipsychotic, levomepromazine, in two patients who were hospitalized in a psychiatric institution. It is important to recognize this manifestation to guide patients about prolonged and pathological erection, to prevent not only possible complications but also to ensure good medication adherence. Clinical cases: This study was analyzed and approved by the Research Ethics Committee according to a substantiated opinion number 6.949.882, and the patient's consent through the Informed Consent Form. Patient 1: Upon admission, he was prescribed thiamine, lorazepam, and levomepromazine. After eight days of regular use of the medication, he presented with prolonged (>4h) painful penile erection without the presence of sexual stimulation or excitement and was diagnosed with priapism. Patient 2: In the final phase of treatment, stable, when after withdrawal of benzodiazepines he presented with initial insomnia, it was decided to optimize the dose of levomepromazine (already being used) from 75 mg to 100 mg at night. One day later, he presented with priapism and was referred to the emergency room and administered local analgesia. Final considerations: Based on the two clinical case reports described, it is possible to infer that priapism was generated as a consequence of the use of levomepromazine, since this type of adverse reaction can already be expected, although not so frequently, from the use of antipsychotics based on the existing literature.