Trazodone and Priapism Risk
Yes, trazodone can cause priapism (painful erections lasting >6 hours), which is a serious adverse effect that can result in irreversible damage to erectile tissue if not promptly treated. 1
Mechanism and Risk Factors
Trazodone causes priapism through its α2-adrenergic receptor antagonism, which can:
- Relax penile vascular and corporal smooth muscle
- Enhance arterial inflow to the penis
- Prolong the detumescence phase of erection approximately 2.4 times compared to placebo 2
Risk factors that may predispose men to priapism while taking trazodone include:
- Sickle cell anemia
- Multiple myeloma
- Leukemia
- Anatomical deformation of the penis (angulation, cavernosal fibrosis, Peyronie's disease) 1
Incidence and Timing
Priapism can occur:
- At any dose, even as low as 50-100mg
- Most frequently within the first 28 days of treatment 3
- In all age groups 3
- In approximately 6.8% of male patients, as reported in a retrospective cohort study of veterans with PTSD 2
Clinical Guidelines
The FDA drug label explicitly warns about priapism risk with trazodone:
- Priapism can result in irreversible damage to erectile tissue
- Men experiencing erections lasting >4 hours should immediately discontinue the drug and seek emergency medical attention 1
The American Urological Association does not recommend trazodone for erectile dysfunction treatment due to:
- Risk of priapism
- Lack of statistically significant efficacy compared to placebo in controlled trials 4
Management of Priapism
If priapism occurs:
- Immediately discontinue trazodone
- Seek emergency medical attention
- Understand that delayed treatment can lead to permanent erectile tissue damage 1
Important Considerations
- Trazodone-induced priapism is one of the most difficult forms of priapism to treat 5
- Cases have been reported after a single 100mg dose 6
- Priapism can occur with various psychotropics, but trazodone has a particularly well-documented association 7
- A double-blind, placebo-controlled trial found trazodone was no more effective than placebo for erectile dysfunction, further supporting that its risk outweighs any potential benefit for this indication 8
Clinical Pearls
- Always inform male patients about this potential side effect before prescribing trazodone
- Instruct patients to discontinue medication and seek immediate medical attention if any unusual erectile problems develop
- Consider alternative medications for insomnia or depression in men with risk factors for priapism
- Monitor patients closely during the first month of treatment when risk appears highest