1016 ■ The Annals of Pharmacotherapy ■ 2002 June, Volume 36 www.theannals.com P riapism is an uncommon adverse effect described dur- ing treatment with different antipsychotic pharmaco- logic agents. Small series of cases 1-3 have been reported as- sociated with the use of the low-potency phenothiazines (chlorpromazine, thioridazine) and single cases 4-6 associat- ed with other antipsychotic drugs (perphenazine, haloperi- dol, thiothixene, fluphenazine, clozapine). Recently, cases of priapism have been associated with new atypical an- tipsychotic drugs such as risperidone, 7,8 olanzapine, 9-11 and zuclopenthixol, 12,13 an antipsychotic from the thioxanthene family. Here, we report an additional case of priapism as- sociated with zuclopenthixol. In this case, unlike the previ- ous ones, the patient was not being treated with other agents associated with priapism. Case Report An unmarried, 31-year-old man had a history of perinatal anoxic en- cephalopathy with severe motor sequelae (tetraparesia) and dyslalia, without associated cognitive deficit or abnormal electrical cerebral activ- ity. Associated with this, from 5 to 12 years of age, the patient presented with involuntary choreo-athetosic movements, for which he was treated with low doses of biperidene (1–2 mg/d). He is a heavy smoker, with daily consumption of more than 40 cigarettes since age 19. Three months before the current hospital admission, he suffered fractures of the left calcaneum, right astragalum, and a compound fracture of the distal end of the right radius. There was no family history of psychiatric disorder. Family members on the paternal side had a history of ischemic cardiopathy and, on the maternal side, diabetes mellitus. The patient had presented with behav- ioral alterations since infancy, which worsened at school age. He was first admitted to a psychiatric unit at 17 years of age after a suicide at- tempt with caustic agents and was diagnosed with personality disorder not otherwise specified on discharge. At 19 years of age, he began a pat- tern of alcohol abuse that reached dependence criteria. After this, he was admitted on numerous occasions to psychiatric units for suicide attempts or conduct disorders. Over this period, he was treated with low or medi- um doses of combined neuroleptics (haloperidol up to 8 mg/d, trifluoper- azine up to 15 mg/d, or periciazine up to 30 mg/d) with benzodiazepines (lorazepam up to 15 mg/d, clorazepate dipotassium up to 75 mg/d). On a sporadic basis, he also received treatment with antimuscarinic agents (biperiden), antidepressants (clomipramine 50 mg/d) and acamprosate. No important adverse effects were observed with any of these medica- tions and, more specifically, no evidence of priapism. The diagnoses 14 of personality disorder not otherwise specified (ICD -9 301.9) and alcohol- abuse dependence (ICD -9 305.0/303) were maintained over the course of treatment, and the patient was also diagnosed with prolonged depres- sive reaction from March to July 1997. The patient was again admitted to our hospital; at this time, the sole treatment consisted of low doses of chlormethiazole, a hypnotic and sedative agent also used for the symptomatic treatment of alcohol with- drawal. On admission, treatment with carbamazepine 300 mg/d, an an- tipsychotic (clothiapine 60 mg/d), and a vitamin complex was initiated. During the first few days after hospital admission, the carbamazepine dosage was gradually increased to 600 mg/d and clothiapine to 120 mg/d, resulting in good tolerance apart from mild sedation. Because of frequent behavioral alterations and the patient’s refusal of oral treatment, occasional intramuscular doses of haloperidol (up to 35 mg/wk) and/or clorazepate dipotassium (up to 350 mg/wk) were administered in addi- tion to his usual treatment. Priapism Associated with Zuclopenthixol Julio Salado, Antonio Blázquez, Raquel Díaz-Simón, Franciso López-Muñoz, Cecilio Alamo, and Gabriel Rubio OBJECTIVE: To present a single case of zuclopenthixol-induced priapism and a literature review. CASE SUMMARY: We report the case of a 31-year-old patient hospitalized due to behavioral alterations and treated with oral zuclopenthixol, an antipsychotic from the thioxanthene family, who developed an acute, painful erection. DISCUSSION: The occurrence of priapism in our patient was related to zuclopenthixol. This adverse reaction is reported for the first time in a patient not concomitantly treated with other drugs associated with the appearance of priapism. The capacity of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on α-adrenergic receptors. CONCLUSIONS: Priapism is an uncommon but potentially serious adverse effect of zuclopenthixol that practitioners, as with many other antipsychotics, should be aware of. KEY WORDS: priapism, zuclopenthixol. Ann Pharmacother 2002;36:1016-8. Author information provided at the end of the text. by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from