December 27, 2013 – The U.S. Food & Drug Administration (FDA) warned today that certain drugs used to treat attention deficit hyperactivity disorder (ADHD) may cause priapism, a condition characterized by prolonged and sometimes painful erections. Methylphenidate ADHD medications linked to this condition include Concerta, Daytrana, Focalin/Focalin XR, Metadate CD/Metadate ER, Methylin/Methylin ER, Quillivant XR, Ritalin/Ritalin LA/Ritalin SR. Based on a recent review of these drugs, the FDA is updating product labeling and patient Medication Guides to include information about the risk of priapism.
How Can ADHD Meds Cause Priapism?
According to the FDA warning, males of any age can suffer from priapism, a condition that occurs when blood in the penis becomes trapped, causing abnormally long-lasting and sometimes painful erections. Methylphenidate drugs used for the treatment of ADHD have been found to cause priapism in certain patients, prompting the FDA to update drug labels and patient Medication Guides with information about this risk. ADHD meds linked to priapism include:
- Concerta (methylphenidate HCl)
- Daytrana (methylphenidate transdermal system)
- Focalin/Focalin XR (dexmethylphenidate hydrochloride)
- Metadate CD (methylphenidate HCl, USP)
- Methylin/Methylin ER (methylphenidate oral)
- Quillivant XR (methylphenidate oral)
- Ritalin/Ritalin LA/Ritalin SR (methylphenidate HCI)
Another ADHD medication called Strattera (generic: atomoxetine) has also been linked to priapism. The condition has been reported to be more common in Strattera users than in those who take methylphenidate; however, due to limitations on available information, the FDA is uncertain as to how often priapism occurs in patients taking either drug.
Symptoms of Priapism
- Painful erection that lasts more than 4 to 6 hours, and is not relieved by orgasm
- Partial erection that persists for several days or more, even if it is not painful
Methods of treatment for priapism depends on what caused the condition. In most cases, a doctor will numb the penis, then use a needle to remove the trapped blood. Often, the doctor will inject a drug that helps relax the narrowed veins.
Patients with semi-erect, painless erections, are more likely to have too much blood flowing into the penis instead of narrowed veins. This often follows trauma to the penis or groin area. After the diagnosis is made, certain patients may be observed without specific treatment.
Priapism caused by high flow typically causes few if any negative health complications. This condition often resolves by itself in a matter of days. If priapism persists, the physician is likely to order an angiogram. Dye that can be detected by x-ray is injected into an artery to locate the excessive blood flow. A procedure to correct the problem may then be ordered.
FDA Recommendation on Methylphenidate
The FDA advises doctors to talk to their patients about these issues, and for perspective methylphenidate users to know the symptoms of priapism prior to beginning a regimen. Young boys, especially those who have not yet reached puberty, may not recognize the problem or may be too embarrassed to discuss it with others.
Additionally, patients are encouraged to read the Medication Guide every time they fill a prescription. Doctors should use extreme caution when considering switching patients from methylphenidate to atomoxetine medications. Patients should not stop using methylphenidate without first consulting their physician.