Intractable priapism associated with herbal stimulants

• Published in: Journal of toxicology. Clinical toxicology 2003-08, Vol.41 (5), p.671-672
• Main Authors: Tuckler, V E, Barton, C, Litner, J, Matinez, J
• Format: Article
• Language: English
• ISSN: 0731-3810

A wide variety of herbal supplements are available to the public over-the-counter without any restrictions and are often advertised as a safe "natural" alternative to prescription medications. A 43 y/o white male without any past medical history presented to the ED complaining of approximately 60 hours of sustained erection. He had used an over-the-counter sexual enhancement drug with the trade name "All Night Long" which contain 16 ingredients including niacin and horny goat weed standardized extract. He took no prescription medications but was taking niacin and ginseng supplements. After taking the supplements, he achieved an erection, but the erection failed to subside and became associated with significant pain. In the ED he received morphine and terbutaline 0.25 mg sc without improvement. Fifty cubic centimeter of blood was aspirated from the cavernosa sinuses, 10 mg neosynephrine in 500 cc NS was irrigated into the cavernosa sinuses and two separate injections of 500 mcg phenylephrine were given but the patient remained without improvement. A Winter's shunt was performed on each side with partial improvement. He received three doses of 200 mg ketaconazole for hormonal ablation while in the hospital and was discharged the next day after complete resolution. Herbal supplements are provided over-the-counter without restriction and are thought by many people to be without risk. However they can be associated with significant negative effects and morbidity.