Risperidone-induced ischemic priapism in a psychiatric patient: a case report

Introduction and importance: Priapism is a urological emergency defined by a prolonged, often painful penile erection unrelated to sexual arousal. Although uncommon, antipsychotic medications such as risperidone, due to their α-adrenergic antagonistic properties, have been implicated in drug-induced priapism. Case presentation: We report the case of a 45-year-old male with a psychiatric history who presented with a painful erection lasting over 24 hours, 3 weeks after resuming risperidone therapy with dose titration. He denied using erectile dysfunction drugs or recreational substances. Clinical evaluation was consistent with ischemic priapism. Initial conservative management with corporal aspiration and drainage was followed by a successful distal T-shunt procedure due to the prolonged duration. On follow-up, the patient reported normal erectile function with no complications. Clinical discussion: This case emphasizes the importance of considering risperidone as a potential cause of priapism, particularly following recent re-initiation or dose adjustment. Early recognition and a thorough medication history are critical for prompt diagnosis and management of this rare adverse drug effect. Conclusion: This case underscores the importance of recognizing priapism as a potential complication of antipsychotic medications, even in resource-limited settings where diagnostic facilities may be unavailable. Timely intervention is essential to reduce the risk of irreversible complications such as erectile dysfunction. Patient counseling on this rare but serious adverse effect may be warranted when initiating or restarting antipsychotic therapy.