Did you tell your Pt. he could get a hard-on...

[Old MD]

from those Trazodone pills?

Yes, you read that right folks.

If you're not warning your patients that one of the sixty quadzillion, rare as a big bang, adverse effects of Trazodone is priapism, you could find yourself owing them half a million bucks.

Might as well start booking 2 hour appointments per patient, per refill, as you're gonna have a lot of "informing" to do. And of course, as always, Medicare will be glad to reimburse you all of - what is it now, 10 Rubles?- for your time.

Oh, and tot up just 3 "gross negligences" like that, and Floridan Liayers would, additionally, also like to destroy the rest of your career and life, after having completely ruined your financial security.



US Medicine - The World's Best Health Care. Coming For A Doctor Near You.

---

Members don't see this ad.

 

[DrQuinn]

Believe it or not, I did tell my patients that when I started them on it in medical school (when the attending would let me start whatever). I think its like 0.5% or sometihng, and female patients can get clitoromegaly as well. I usually say it tongue in cheek and the patients laughs it off too.

 

[edmadison]

from those Trazodone pills?

Yes, you read that right folks.

If you're not warning your patients that one of the sixty quadzillion, rare as a big bang, adverse effects of Trazodone is priapism, you could find yourself owing them half a million bucks.

Might as well start booking 2 hour appointments per patient, per refill, as you're gonna have a lot of "informing" to do. And of course, as always, Medicare will be glad to reimburse you all of - what is it now, 10 Rubles?- for your time.

Oh, and tot up just 3 "gross negligences" like that, and Floridan Liayers would, additionally, also like to destroy the rest of your career and life, after having completely ruined your financial security.



US Medicine - The World's Best Health Care. Coming For A Doctor Near You.

This is a very well known side effect of the medication and a reason why many do not prescribe the medication to men. Part of your job as a doc is to discussed common and/or sever side effects.

Ed

 

[edinOH]

This is a very well known side effect of the medication and a reason why many do not prescribe the medication to men. Part of your job as a doc is to discussed common and/or sever side effects.

Ed

Please.

Do you explain every possible side effect of every medication you give to every patient?

Off the high horse.

 

[gwen]

so what purpose do the labels and fine print serve if your a** is going to be sued no matter what?

 

[Old MD]

so what purpose do the labels and fine print serve if your a** is going to be sued no matter what?

The fine print is to protect the Drug company. Not you. In fact, I imagine labels make it easier for You to get sued. If there was no documentation that priapism was an extremely rare s/e of trazadone, it would be hard for the plaintiff to make the case that the drug caused it.

 

[MacGyver]

http://www.rxlist.com/cgi/generic/traz_ad.htm

Here is a list of all reported side effects of trazodone:

According to the idiotic precedent set by this lawsuit, you have to warn patients taking trazodone that they may experience edema, blurred vision, constipation, dry mouth, both hypertension AND hypotension, shortness of breath, syncope, tachycardia, palpitations, anger/hostility, confusion, decreased concentration, disorientation, dizziness, lightheadedness, drowsiness, excitement, fatigue, headache, insomnia, impaired memory, nervousness, bad taste, diarrhea, nausea, vomiting, aches/pains, incoordination, paresthesia, tremors, decreased libido, decreased apetite, red/irritated eyes, malaise, sinus congestion, nightmares, sweating, tinnitus, weight gain AND weight loss.

Remember folks, according to the esteemed jury and judge in this case, you cant just give them a list of this stuff, you HAVE TO TELL THEM VERBALLY EVERY SINGLE POSSIBLE SIDE EFFECT OF THE DRUG!

BTW, who ever said that erection was a "common" side effect was mistaken. In didnt appear in this list at all.

This is yet another example of an idiotic court case, along with idiotic judges and jury members.

 

[NaeBlis]

Please.

Do you explain every possible side effect of every medication you give to every patient?

Off the high horse.

You should discuss the common ones, and priapisim is a very common one. Common step 1/2 question, shows up in all the review books. Just the same, lawyers suck.

 

[MustafaMond]

[
BTW, who ever said that erection was a "common" side effect was mistaken. In didnt appear in this list at all.

Again you show your ignorance of medicine.
Trazodone and other older antidepressants are the #1 cause of drug-related priapism.

 

[Old MD]

This is a very well known side effect of the medication and a reason why many do not prescribe the medication to men.
Ed

This is a very rare s/e that affects a fraction of 1% of users and is a reason why most prescribe the medication no differently in men than in women.

Just thought I'd correct some blatant typos in your silly little boast.

So, tell me, how do you prescribe celebrex? Do you tell your patients that they can get ataxia taking it? Meningitis? Exfoliative dermatitis? Suicide (It's in the package insert)? Sudden cardiac death?

Why don't you let us uninformed docs know how to tell a poor 65 year old black woman with little education the side effects of celebrex, and tell it so well she understands it ("informed consent"..), and do this in a reasonable time (for those of us who may have to see slightly more than 1 patient every 5 hours?)

Do you know what they are? Do you know how many are there? I counted around 175*.




*I may have double counted a few.

 

[Old MD]

You should discuss the common ones, and priapisim is a very common one.

Priapism is "a very common" side effect of Trazodone?

There is a difference between "common" and "known" (especially "known to MSIIs who are trying to kill Step 1" )

If trazodone induced-priapism is so common, then why is it publishable when it happens?

Actas Urol Esp. 2000 Nov-Dec;24(10):840-2.
Trazodone-induced priapism

[Article in Spanish]

Correas Gomez MA, Portillo Martin JA, Martin Garcia B, Hernandez Rodriguez R, Gutierrez Banos JL, del Valle Schaan JI, Roca Edreira A, Rado Velazquez MA, Hernandez Castrillo A.

Servicio de Urologia, Hospital Universitario Marques de Valdecilla, Santander, Cantabria.

We present a 41 year old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

Publication Types:
Case Reports
Review
Review of Reported Cases

PMID: 11199305 [PubMed - indexed for MEDLINE]

Also see: Priapism associated with conventional and atypical antipsychotic medications: a review by Compton MT, Miller AH. PMID: 11411819

They reviewed the literature from 1966, and found 29 publications (some were other review articles, not original case reports). They conclude that virtually all antipsychotic medications have been reported to rarely cause priapism due to their alpha-adrenergic antagonism.

 

[Old MD]

Again you show your ignorance of medicine.
Trazodone and other older antidepressants are the #1 cause of drug-related priapism.

Actually you are not disproving what MacGyver said. I am not sure if you're being disingenous or merely don't see the difference.

It's like saying "Ebola virus and other similar RNA viruses are the #1 cause of viral hemorrhagic fevers".

Sure they are.

But how common are viral hemorrhagic fevers?

If you look at "drug-induced priapism", sure, trazodone is a leading cause.

But that is not the question. The question is how common is trazodone induced pripaism?

 

[MacGyver]

Again you show your ignorance of medicine.
Trazodone and other older antidepressants are the #1 cause of drug-related priapism.

Read my post again and get back to me when your command of the English language has reached a sufficiently advanced level to handle introductory reading comprehension.

 

[MacGyver]

You should discuss the common ones, and priapisim is a very common one. Common step 1/2 question, shows up in all the review books. Just the same, lawyers suck.

WTF?

Thats absolute crap. Priapism, is in no sense of the word, a "very common" side effect of the drug. One source I read put the occurrence at less than 1 in 6000 men. Do you consider 0.016% occurrence to be "very common?"

 

[juddson]

The last two sentences of the story:

"Juries have been generally supportive of physicians in this respect and do not require them to explain every minor or uncommon side effect. This case is the exception."

These words struck me more than anything else because I think they go to the heart of the matter here - that this case is an exception (a bad one, in my opinion) and not the rule. I expected to see something like this (or at least some language on the "duty to warn" throughout the story).

In fact, there is a rich jurisprudence on the "duty to warn", and courts have generally held (with respect to pharmaceuticals and medical procedures) that complications which fall below a certain threshold of probability do NOT give rise to a duty to warn because, they have determined, no reasonable person would refuse the treatment. The typical rule is set forth below (taken from Alaska's Code - which is indicative of many):

"A physician is liable for failure to obtain the informed consent of a patient if the claimant establishes by a propenderance of the evidence that the provider failed to inform the patient of the common risks and reasonable alternatives to the proposed treatment or procedure, and that but for the failure the claimant would not have consented to the proposed treatment or procedure." (emphasis mine)

Likewise, Many courts have determined that the language set in emphasis above means that the disclosure must be judged not by a standard set by the community in which the physician practices (ie., what would a reasonable physician do), but rather on a subjective basis, whether the disclosure is sufficient to permit a "reasonable patient" to make an informed decision. Under the reasonable patient rule, a physician must disclose those risks which are material to a reasonable patient's decision concerning treatment.

This case should not have made it past summary judgment. A 1/6000 risk of priapism is simply not "material" in the scheme of things.

Perhaps the real tragedy here is that the jury determined tha patient was 49% at fault for the injury for failing to see a doctor in a timely manner. Obviously this state subscribed to the rule that where a plaintiff is 50%, or more, responsible for the injury he is entitled to collect nothing. The Jury (obviously) knew about this rule is brought this patient in just under it in order to give him something. In the event that this rule was part of the jury instructions (possible), it should have been excluded. They would have come back with the patient being at least 50% to blaim, and he wouldn't have gotten squat.

In the end, I think the author of the article is right - this is an exceptional case.

Judd

 

[juddson]

On the other hand, I think there may be more to this than what is being suggested by people like MacGyver on this thread. For instance, on most of the websites (a random sample I took) discussing Trazodone, there is is laundry listing of side effects, all without comment. Yet, most of these sites choose to single out and comment on the risk of Priapism seperately. Why is that?

Here's three:

http://holisticonline.com/Remedies/Depression/dep_antidepressant-serotonin-antagonists.htm
Side Effects of Trazodone

Dizziness
Dry mouth and throat
Upset stomach
Constipation
Blurred vision
Headache
Fatigue
Sleepiness
Confusion
Anxiety
Priapism (rare, see discussion)

Stomach upset (such as nausea) is a common side effect of serotonin antagonists especially when the medicine is taken on an empty stomach. Take it with food to minimize this.

Trazodone and nefazodone may cause dry mouth in some patients.

Dizziness

Both drugs can cause a temporary drop in blood pressure when you stand up, resulting in dizziness or light-headedness. This is more likely in case of Trazodone than nefazodone. To minimize this problem:

Get up more slowly
Walk in place when you get up so as to "pump" blood back to your heart from your legs
Use support stockings
Take adequate amounts of fluid and salt to prevent any dehydration

Priapism

This is sometimes observed as a side effect of trazodone. Priapism involves an involuntary erection of the penis. It is quite rare. (about one male patient out of 6,000.) If you experience this side effect, it need to be treated immediately. (Call your doctor or go to the emergency room immediately if you notice this.) Otherwise, it can lead to damage of the penis and permanent impotence (the inability to get an erection). Some patients may require surgery to correct the priapism. Injecting a drug like epinephrine directly into the penis can sometimes counteract the priapism if you catch it quickly enough. Nefazodone does not cause priapism.

http://www.medicinenet.com/trazodone/article.htm
SIDE EFFECTS: The most commonly noted side effects associated with trazodone are nausea, dizziness, insomnia, agitation, tiredness, dry mouth, constipation, lightheadedness, headache, low blood pressure, blurred vision, and confusion. Priapism (including clitoral priapism in women), a painful condition in which the penis (or clitoris) remains in an erect position, has been reported in patients receiving trazodone. Priapism occasionally results in permanent impairment of erectile function or impotence. Patients should be warned of the possibility of priapism and told to discontinue the drug at once and consult with their physician if this reaction occurs. Trazodone also may affect ejaculation, orgasm and libido.

Here's a site that sets out the issue with a seperate "WARNING" heading:

http://www.healthyplace.com/medications/trazodone.htm
Description
This medicine, Trazodone, is a modified cyclic antidepressant. Trazodone belongs to the group of medicines known as antidepressants or "mood elevators." It is used to relieve mental depression and depression that sometimes occurs with anxiety.

Pharmacology
Trazodone's mechanism of action in humans is not clear.

In animals, trazodone HCl selectively inhibits serotonin uptake by brain synaptosomes and potentiates the behavioral changes induced by the serotonin precursor, 5-hydroxytryptophan.

Peak plasma levels occur approximately one hour after dosing when trazodone HCl is taken on an empty stomach or two hours after dosing when taken with food.

For those patients who responded to trazodone HCl in clinical trials, one-third of the inpatients and one-third of the outpatients had a significant therapeutic response by the end of the first week of treatment. Three-fourths of all responders demonstrated a significant therapeutic effect by the end of the second week. One-fourth of responders required 2-4 weeks for a significant therapeutic response.

Indications and Usage
For relief of depression.

Contraindications
Trazodone is contraindicated in patients hypersensitive to trazodone.

Warnings
Trazodone has been associated with the occurrence of priapism. In approximately 1/3 of the cases reported, surgical intervention was required and, in a portion of these cases, permanent impairment of erectile function or impotence resulted. Male patients with prolonged or inappropriate erections should immediately discontinue the drug and consult their physician. If the condition persists for more than 24 hours, it would be advisable for the treating physician to consult a urologist or appropriate specialist in order to decide on a management approach.

Trazodone is not recommended for use during the initial recovery phase of myocardial infarction.

Caution should be used when administering trazodone to patients with cardiac disease, and such patients should be closely monitored, since antidepressant drugs (including trazodone) have been associated with the occurrence of cardiac arrhythmias.

Here's what I'm getting at: These are just the first couple of sites that come up on google search. And all of them make special mention of priapism as a side effect, in addition to merely listing many other common side effects. Some of these sites explicitly say that a warning for priapism should be given.

I slowly see a case being made that the doctor (not sure how I feel about the pharmacist) probably should have mentioned priapism as a possible side effect. Why? Because even though it is rare (1/6000 by some reports) the condition is serious (1/3 needs surgical intervention according to one site).

There is NO discussion in the article about the standard of disclosure for priapism when prescribing this drug by physician in the community. Yet I am betting evidence to that effect was offered in court.

I know all of you think this case is a sham and a fraud. And I was inclined to agree. But after seeing the emphasis widely available (and in preference to the emphasis given to OTHER side effects), perhaps there needs to be more said about whether the warning should have been given.

Judd

 

[Apollyon]

On the other hand, I think there may be more to this than what is being suggested by people like MacGyver on this thread. For instance, on most of the websites (a random sample I took) discussing Trazodone, there is is laundry listing of side effects, all without comment. Yet, most of these sites choose to single out and comment on the risk of Priapism seperately. Why is that?

Here's three:

Here's a site that sets out the issue with a separate "WARNING" heading:


Here's what I'm getting at: These are just the first couple of sites that come up on google search. And all of them make special mention of priapism as a side effect, in addition to merely listing many other common side effects. Some of these sites explicitly say that a warning for priapism should be given.

I slowly see a case being made that the doctor (not sure how I feel about the pharmacist) probably should have mentioned priapism as a possible side effect. Why? Because even though it is rare (1/6000 by some reports) the condition is serious (1/3 needs surgical intervention according to one site).

There is NO discussion in the article about the standard of disclosure for priapism when prescribing this drug by physician in the community. Yet I am betting evidence to that effect was offered in court.

I know all of you think this case is a sham and a fraud. And I was inclined to agree. But after seeing the emphasis widely available (and in preference to the emphasis given to OTHER side effects), perhaps there needs to be more said about whether the warning should have been given.

Judd

What it makes ME think of, is this is how someone got burned - and that's why it's mentioned specifically, although very rare; then, it builds on itself, and, as you say, a case is slowly made against the doctor.

 

[juddson]

What it makes ME think of, is this is how someone got burned - and that's why it's mentioned specifically, although very rare; then, it builds on itself, and, as you say, a case is slowly made against the doctor.

Yes, but there is no evidence of that. How many cases have been brought on this issue - other than the one being discussed on this thread? And if this is the only one (could very easily be), I'm under the impression it is recent and it would be unlikely it moves through so quickly. Morever, how many cases TOTAL have been brought and lost (by the doc) for failure to warn of ANY side effect from the pharma in question? I'm guessing PLENTY. And yet these OTHER side effects are not being singled out for special attention.

At least one of those sites suggested that in 1/3 of the cases of priapism from the pharma, surgery was required? That suggests this issue has been watched and studied. NOT something yo do from one case, ordinarily.

Finally, I think you are being disengenuous. That is a fine impression after the fact. But, had you not heard of this particular case I THINK you would have read these websites and concluded in fact that the issue was a real one - it would NOT have been your first thought to say "gee, I bet some doc was sued over that - no way is priapism a real problem".

judd

 

[Skoundrel]

Can't you just give them a copy of the drug insert and tell them to read it and call it a day?

 

[Old MD]

Juddson, your first post is good. I didn't know about that law. It is intelligently written.

About your question re: priapism warnings for traz. This relates to the way drug testing is conducted and studied before approval. In Phase I & II clinical testing, close attention is paid to safety issues and side effect profiles. Most of the known a/e of most drugs are discovered in these phases. Once a drug passes those phases, the phase III trial evaluate efficacy. If the drug is safe + efficacious, FDA approves it.

But the things is, most Phas I trials involve <100 people, Phase II <300, phase 3 ~500-3000 people.

So the number of people a drug is tested on right up until it is approved is often <4-5000 people. In fact often it is very much smaller.

Rare side effects may not show up when the n is too small compared to the rate of that side effect. So these side effects are only discovered after the drug has been released unto the population at large and is widely in use. And after doctors have "learnt" about it and started using it.

This is what happened to trazadone. Priapism with trazadone was a post introduction discovery. If you look at the primary literature, it is the recent papers that are specifically warning physicians who prescribe the drug to "be aware of this adverse event" and obtain "urgent urological consultation for patients recently begun on trazadone who develop priapism".

One reason this suggestion is made is to expedite rapid diagnosis. 50% of priapism is idiopathic, 20-30% is drug induced. Someone who comes in with it, who is on traz, should have it stopped and get uro consultation.

I think the reason the warning now appears in pack inserts is that after the link was discovered, it became a legal necessity. The inevitable lawsuits would have followed, especially in that subgroup of patients who became impotent. Most men who take a medication to help with their sleep will be pretty upset if they became impotent overnight: regardless of how unfair it would be to expect the drug company and/or those "early" prescribing doctors to have known about this, I'm sure a number of suits were brought. The drug companies who write the pack insert (which by the way is what you're reading online) would of course want to cover their asses over every conceivable effect.

The thing about priapism is, it is an adverse effect that many men will find "intolerable" (==> higher likelihood of suit compared to say, nausea) it is potentially reversible if identified early, and it has more potential to have permanent effects (compared to say, constipation).


CONT

 

[Old MD]

Which brings us to the original question. Should we warn patients?

Ideally, you would like "perfect communication":

1. everything that is "known", is known to the doctor,

2. everything that is known to the doctor, is transmitted to the patient (in a way that is understandable to them). (unless the patient does not wish it to be).

In practice, this is impossible.

1. The Father of modern EBM, Sackett, once estimated the amount of reading a doctor had to do just to keep abreast in his own specialty. If I remember right, it was 30 papers a week, every week, every year of his practising life.

If you have been in medicine for any length of time, you would know that this is far above what even many academics manage.

2. Even if the docotr knew everything there was to know, to transmit this in the managed care environment, to a human patient of average intlligence, with no training in medicine, is also impossible.

So you pick and choose. And try to do a relevant job. I personally would not fault a doctor for not mentioning priapism as s/e of traz and I suspect a vast majority of my colleagues would feel the same way.

 

[Sessamoid]

Juddson,

As to why so many search hits turned up priapism as a problem with Trazodone, it's really no different than any other thing on the internet. Do a search for anything. What do a lot of hits turn out to be? Sex. Anything sexual gets talked about a lot. Impotence doubly so. If you have a fairly public email, how many emails a day do you get for magical cures for impotence?

Priapism is a pretty damned uncommon, even rare, side effect of Trazodone. Anybody with half a brain isn't going to wait 30 hours before coming to the doctor for a persistent, painful erection. And priapism is pretty damned painful, at least from the few cases of it that I've seen. The only case of trazodone-induced priapism I've seen was in the state prison hospital in an inmate who had illicitly obtained the medication to achieve exactly that side-effect. Personally, I think anybody that stupid ought to be taken out of the gene pool anyway.

I agree that this is likely an outlier as med-mal cases go, but it's exactly these cases that get publicized and puts the fear of the devil into us all. Crap like this is why we practice defensive medicine.

 

[Cassidy61]

i'm still chuckling that this ***** walked around for 30 hours with a raging hard on and didn't think that it was abnormal!!!

 

[Old MD]

i'm still chuckling that this ***** walked around for 30 hours with a raging hard on and didn't think that it was abnormal!!!

That is really the crux of the case. These idiots have simply no clue of the concept of responsibility.

And the court system rewards them for it.

I think even if i were a lay person, I'd get worried if I had an erection for even 1 hour in the absence of any sexual stimulation. This guy waited not one, not two, not five, not 10, not 20 hours, but 1.5 DAYS before he decided something was wrong.

And of course, the jury decides he is exactly 49% at fault. What a surprise...

 

[daisygirl]

That is really the crux of the case. These idiots have simply no clue of the concept of responsibility.

And the court system rewards them for it.

I think even if i were a lay person, I'd get worried if I had an erection for even 1 hour in the absence of any sexual stimulation. This guy waited not one, not two, not five, not 10, not 20 hours, but 1.5 DAYS before he decided something was wrong.

And of course, the jury decides he is exactly 49% at fault. What a surprise...

I agree that the fact that the person walked around for a day with an erection is simply irresponsible on his part. However, why isn't it an issue that he didn't even bother reading the side effect profile- the pharmacist did give him the necessary paper that denoted all of the potential side effects.

The jury's ruling on this case stinks.

 

[MacGyver]

judd,

Just because something is a dangerous side effect doesnt mean it necessarily deserves a verbal warning and that a written list of toxicities wont do.

There are many drugs which have an adverse side effect that occurs in less than 1% of patients, but yet this adverse side effect is often fatal.

A typical drug has 20 "common" side effects and 15 "rare" effects that have only been reported in literature or occur in far less than 1% of the patient sample. Now lets assume that all 15 of the "rare" effects are fatal. Do you honestly believe its the responsibility of the doctor to discuss EVERY SINGLE ONE OF THOSE with the patient? Remember, the doc gave the guy a list of everything, but the jury said that wasnt good enough; that it HAD TO BE A VERBAL WARNING.

In an ideal world, doctors would have time and resources to sit down with every patient for 2 hours and discuss every possible adverse effect of a drug.

Thats the problem with the present legal system and why we need special medical courts. We need specially trained MD/JDs who understand the realities of medical practice and quit punishing doctors for not living up to unreasonable "pie in the sky" ideological models of how medicine "should" be practiced in utopia. This is not utopia, and its totally UNREASONABLE to punish doctors on the basis of a utopian-type medical practice that will NEVER EXIST!

 

[beriberi]

did anyone read the bit at the bottom where they state that this is a "composite case" based on real events (but not real events).

I think it is silly to debate what should have been done by the patient, the doctor, etc when the story is not true.

show me a real case where a dr was punished for not revealing an uncommon side effect of a drug.

 

[Apollyon]

Finally, I think you are being disengenuous. That is a fine impression after the fact. But, had you not heard of this particular case I THINK you would have read these websites and concluded in fact that the issue was a real one - it would NOT have been your first thought to say "gee, I bet some doc was sued over that - no way is priapism a real problem".

Wow...you are harsh. In no way am I saying that it's not a real problem (have you ever seen one? I have). All I'm saying is, why is it specifically mentioned? Because, not that someone suffered from it, but litigated successfully from it. If there was another rare point that someone had litigated and won about, that also would get a specific mention. There is NOTHING disingenuous about that. It's CYA.

 

[WatchingWaiting]

Isn't the most important advice you give a patient when prescribing a drug (any drug)-- "if you experience any adverse changes, contact our office immediately?" I mean, the idea that you are going to as a physician waste five or ten minutes of every visit going though every serious side effect that has been reported for all drugs you prescribe to a patient is just brain-dead. Pretty much every drug that is prescribed has had at least a couple of people who have died or had life-altering changes due to an unexpected reaction to it. The idea is that you as a patient have a certain level of responsibility to be on the lookout for adverse reactions when you are first prescribed anything. As mentioned, who is going to walk around with an engorged, painful penis for 30 hours without asking for some form of medical consultation? Especially if it starts a few hours after taking a new medicine?

 

[euromd]

Priapism

This is sometimes observed as a side effect of trazodone. Priapism involves an involuntary erection of the penis. It is quite rare. (about one male patient out of 6,000.) If you experience this side effect, it need to be treated immediately. (Call your doctor or go to the emergency room immediately if you notice this.) Otherwise, it can lead to damage of the penis and permanent impotence (the inability to get an erection). Some patients may require surgery to correct the priapism. Injecting a drug like epinephrine directly into the penis can sometimes counteract the priapism if you catch it quickly enough. Nefazodone does not cause priapism.

(underline mine)

is this one male patient out of 6000 male patients? or one male patient out of 6000 male and female patients combined?

if the assumption is the former, and it is assumed that trazodone is given equally to female and male patients, then priapism really only appears in 1/12000 total patients.

too many assumptions...

-S

 

[dbiddy808]

I frequently prescribe trazodone (50-100 mg, which is low-dose) for insomnia as it is reported to have less drowsiness than even ambien. I can honestly say, that although I know about the side-effect of priaprism, I have never mentioned this to a patient. I will do this from now on.