A male client taking trazodone 100 mg PO at bedtime calls th… | MyMerci
Medical EmergenciesPA
Question
A male client taking trazodone 100 mg PO at bedtime calls the clinic to report a painful erection lasting 3 hours. Which is the nurse's most appropriate response?
1"This is a normal side effect that will improve over time."
2"Apply ice and lie down; it should resolve on its own within a few hours."
3"Go to the emergency department now — this could be priapism, which is a urologic emergency."✓ Correct answer
4"Take an extra dose of trazodone to help you fall asleep."
Explanation
Correct (2): Priapism (erection >4 hours) is a rare but serious adverse effect of trazodone caused by alpha-1 blockade. The 3-hour threshold demands emergency evaluation — irreversible ischemic tissue damage and erectile dysfunction can occur after ~4 hours. ED management may include cavernosal aspiration, intracavernous phenylephrine, or surgical decompression. (1) Watchful waiting risks permanent damage. (3) Additional trazodone worsens the problem. (4) NOT a normal effect — it is a urologic emergency.
In-depth explanation
Memory Tip Trazodone = "TRA-ZZZ-Done" for sleep, but watch for priapism (4-hour rule). Caution All male clients starting trazodone must receive priapism teaching — emphasize ED visit BEFORE 4 hours, not after.
Clinical scenario
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."
Key concepts
Priapism — Persistent (>4 hours), often painful erection unrelated to sexual stimulation; a urologic emergency that can cause permanent erectile dysfunction if untreated.
Alpha-1 blockade — Trazodone's mechanism for both sedation and priapism risk; reduces sympathetic vasoconstriction in penile vasculature.
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.