A client taking trazodone reports a painful erection that has lasted more than 4 hours. Which instruction should the nurse give?
1Wait until the next scheduled visit because this effect resolves without treatment.
2Stop taking trazodone and seek emergency medical attention now.✓ Correct answer
3Apply an ice pack and take the next trazodone dose at the usual time.
4Take an extra trazodone dose and rest until the erection subsides.
Explanation
An erection lasting more than 4 hours during trazodone therapy may be priapism. The client should discontinue trazodone and seek emergency medical attention immediately, whether the erection is painful or not. Delayed treatment can cause irreversible erectile-tissue damage. Waiting, home measures, or taking additional trazodone is unsafe.
Clinical reasoning Priapism traps blood in the erectile tissue. Prolonged ischemia can lead to fibrosis and permanent erectile dysfunction.
Decision rule An erection lasting longer than 4 hours while taking trazodone is an emergency: stop the medication and obtain immediate emergency evaluation.
Scenario 38-year-old male on trazodone 100 mg PO HS for insomnia × 6 weeks. He calls the after-hours line: "I've had a painful erection for 3 hours and it won't go away."
Priapism — A prolonged erection unrelated to sexual stimulation that can cause ischemic tissue injury and permanent dysfunction if not treated promptly.
Trazodone — A serotonergic antidepressant associated with rare prolonged erections and priapism requiring immediate emergency attention.
Off-label sleep use — Trazodone is widely used off-label for insomnia at sub-antidepressant doses (25-100 mg HS); less Beers-flagged than benzodiazepines in some scenarios but still requires priapism counseling in males.