From the Guidelines
If you're experiencing a prolonged erection (priapism) after taking too much Viagra, the most effective treatment is an injection of intracavernosal phenylephrine, which should be administered as soon as possible to reduce the risk of permanent tissue damage and erectile dysfunction. This is based on the most recent and highest quality study available, which recommends intracavernosal phenylephrine as the initial treatment option for prolonged erections of four hours or less following intracavernosal injection pharmacotherapy for erectile dysfunction 1.
Key Considerations
- Prolonged erections can be caused by excessive doses of Viagra, which disrupts the normal balance of blood flow regulation in the penis.
- Priapism lasting more than 4 hours can cause permanent tissue damage and erectile dysfunction.
- Intracavernosal phenylephrine is a highly effective treatment for prolonged erections, and its use is recommended by the American Urological Association Education and Research, Inc. 1.
- Other potential conservative treatments, such as applying ice to the penis, ejaculation, exercise, laying supine, and penile compresses, may be considered, but their effectiveness is not supported by high-level evidence 1.
Treatment Approach
- Patients with prolonged erections should be instructed to return to the office if they have an erection lasting more than 4 hours.
- Clinicians should administer intracavernosal phenylephrine as the initial treatment option for prolonged erections of four hours or less following intracavernosal injection pharmacotherapy for erectile dysfunction 1.
- In cases where conservative management is ineffective, intracavernosal phenylephrine should be utilized as a treatment option 1.
- Surgical intervention may be necessary for severe cases, but this should only be considered after other treatment options have been exhausted.
Prevention
- To prevent prolonged erections, it is essential to take Viagra exactly as prescribed and never exceed the recommended dose.
- Patients should be counseled on the risks of prolonged erections and the importance of seeking medical attention immediately if they experience an erection lasting more than 4 hours.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Priapism
- Priapism is a condition characterized by a prolonged and persistent erection of the penis without sexual stimulation, and it can be treated with various methods, including intracavernous vasoconstrictive agents or surgical shunting 2.
- Intracorporeal phenylephrine has been shown to be an effective treatment for priapism, with a study demonstrating that 8 out of 9 patients responded with detumescence after injection 3.
- Other treatment options include intracavernous injection of methylene blue or selective penile arterial embolization, which can be used to manage high and low flow priapism 2.
Management of Ischemic Priapism
- Ischemic priapism is a urologic emergency that requires time-sensitive management, and treatment options include conservative management, corporal irrigation, pharmacologic therapy, and surgery 4.
- The American Urological Association (AUA) and the European Association of Urology (EAU) recommend penile aspiration in conjunction with intracavernosal injection of sympathomimetics as the initial management of ischemic priapism 4.
- Intracavernosal phenylephrine has been shown to be superior to other agents due to its demonstrated efficacy and limited systemic side effects 4.
Safety and Efficacy of Phenylephrine
- A study examined the safety and efficacy of hourly, high dose phenylephrine for acute ischemic priapism and found that it was effective in achieving detumescence in 63.9% of patients 5.
- The study also found that nonoperative resolution of acute ischemic priapism with phenylephrine does not appear to be dose-dependent, and hemodynamic changes secondary to phenylephrine administration may be underreported 5.
- Another study reported the successful management of psychotropics induced stuttering priapism with pseudoephedrine in a male patient with schizophrenia, highlighting the potential use of pseudoephedrine in the treatment of priapism 6.