Priapism in Emergency Medicine Medication

  • Author: Colin M Dougherty, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Mar 12, 2012
 

Medication Summary

Phenylephrine, an alpha-agonist, is very effective in the management of priapism, especially priapism due to iatrogenic injection. Terbutaline is also effective in some cases. The exact mechanism is not clear.

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Alpha-adrenergic agonists

Class Summary

These agents have been used successfully in the treatment of priapism, possibly due to their sympathomimetic vasopressor activity.

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Phenylephrine (Neo-Synephrine)

 

A strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. Increases peripheral venous return. The drug is best administered in a dilute solution; add 10 mg (usually 1 mL) of phenylephrine to 499 mL of saline 0.9%, yielding a solution with 20 mcg/mL.

Primary benefit in treatment of priapism is vasoconstrictive properties.

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Pseudoephedrine (Sudafed)

 

Stimulates vasoconstriction by directly stimulating alpha-adrenergic receptors.

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Beta-adrenergic agonists

Class Summary

Agent has been shown to be effective, but the reason is not yet fully elucidated.

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Terbutaline (Brethaire, Bricanyl)

 

Selective beta2-adrenergic agonist used successfully in the treatment of priapism.

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Guanylate cyclase inhibitors

Class Summary

Have second messenger inhibitory effect, affecting muscle relaxation.

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Methylene blue (Urolene Blue)

 

Inhibits smooth muscle relaxation.

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Contributor Information and Disclosures
Author

Colin M Dougherty, MD  Staff Physician, Department of Emergency Medicine, Tri-City Medical Center; Staff Physician, Department of Emergency Medicine, Kaiser-Permanente, San Diego Medical Center/Kaiser Foundation Hospital

Colin M Dougherty, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Allison J Richard, MD  Assistant Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California; Associate Director, Division of International Medicine, Attending Physician, Department of Emergency Medicine, LAC+USC Medical Center

Disclosure: Nothing to disclose.

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS  Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, British Medical Association, and Fellowship of the Australasian College for Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard H Sinert, DO  Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Tyson Pillow, MD.

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Priapism. Corporeal relaxation causes external pressure on the emissary veins exiting the tunica albuginea, trapping blood in the penis and causing erection.
 
 
 
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