Recurrent priapism in a military veteran receiving treatment for PTSD

Introduction: For veterans struggling with post-traumatic stress disorder (PTSD), symptomatic control often requires multiple psychotropic agents. We describe a case in which a young veteran experienced recurrent priapism while receiving treatment for PTSD with several medications, most notably trazodone and prazosin. Case Description: Our patient presented to the emergency department with priapism, approximately 3 months after beginning a pharmacologic regimen of escitalopram, prazosin, trazodone, and methylphenidate for PTSD. Detumescence was achieved, and he was instructed to discontinue trazodone. Approximately 1 month after discontinuation, he presented to the emergency department with recurrent priapism. Our patient had no obvious risk factors, including sickle cell disease, cocaine use, or utilization of phosphodiesterase type 5 inhibitors. After his second episode, our patient discontinued prazosin, and after 6 weeks had not experienced recurrence. Discussion: Food and Drug Administration-approved medications alone are often inadequate to treat-specific symptoms, especially those related to sleep. Consequently, trazodone and prazosin are frequently used off-label. Although priapism has been associated with these medications, there are currently no data available regarding the incidence of priapism related to dose or combination with other agents. Combat veterans may represent a population at higher risk for priapism given their often complex psychotropic regimens.