Is there an anti-Viagra?

June 27, 2009 12:55 PM

Drugs for trazodone-induced night-time priapisms? Or other drugs for sleep for which I probably won't develop a tolerance? (Somewhat NSFW.)

I have been taking trazodone for a few months to help me sleep, and it works great, really given me a new lease on life. Unfortunately, it's also giving me erections while I sleep, which probably last for hours. I take 7.5 mg of trazodone when I go to bed, then another 7.5 when I wake up about five hours later, and that lets me sleep for another two hours or so. So any one erection in isolation probably isn't damaging, but over the last few weeks, I've been noticing an ache in my penis which is worst shortly after I wake up, just after the erection subsides, so I think that chronically, they are causing a problem. And the ache is getting worse. It's caused me noticeable discomfort for most of today.

I could go off the trazodone, but actually if I was forced to choose, I think I would rather sleep this well than maintain a functioning penis. So I'm looking for either a drug which will mitigate the erection (preferably just while sleeping) or another sleeping drug. But benzos and Lunesta don't do me any good at all.

posted by anonymous to health & fitness (15 comments total)

Have you spoken to your doctor about this side effect?
posted by rhapsodie at 1:20 PM on June 27

I manage the mental health caseload for a drug court and the two most common drugs my clients are prescribed for insomnia that are non-habit forming are the anti-histamine Vistaril and the anti-psychotic medication Seroquel. I am not recommending you take either of these medications, the widespread off-label use of Seroquel especially has always troubled me, as I don't think there is much data on the safety of its long term use as a sleep medication and it, like other anti-psychotics, does carry some small risk of inducing tardive dyskinesia, an incurable and often debilitating Parkinson's-like neurological disorder.
posted by The Straightener at 1:23 PM on June 27

I have sleep issues, trouble falling asleep and trouble staying asleep. I resisted non-otc sleeping pills for years, afraid I'd get hooked, but my insomnia was getting out of control, I'd be awake for days and days at a time. Not good. So my doctor prescribed ambien and lunesta. lunesta didn't help at all. Ambien was great for a short while, but eventually I'd just wake up after 2 hours or so. When I got up to the max dosage and one or two hours of sleep was more frustrating than no sleep at all, my doctor prescribed a low dose of seroquel (25 mg). Insomnia is an "off label" use for the med. It was a good combo, the ambien helped me fall asleep and the seroquel helped me stay asleep. I probably didn't need the ambien, after I ran out, I was fine with just seroquel.

I was on it for about 3-4 months, then I stopped because I lost my insurance and seroquel is expensive. In this time, I did not develop a tolerance (it usually takes me only a week or so to develop a tolerance to anything used to treat insomnia). I did not notice any side effects, though the wikipedia does list many possible side effects. I'm female so even if it did cause night-time priapisms, I would not know, though that isn't listed as a side effect in the wikipedia article.

Obviously, you should see your doctor about the side effects you're experiencing. If there's no solution, ask him if seroquel might be right for your sleep disorder (wow, I just sounded like a pharmaceutical commercial).

Good luck. Insomnia is hellish.
posted by necessitas at 1:48 PM on June 27

Forgot to add, you might want to ask this question on CrazyBoards, too.
posted by necessitas at 1:52 PM on June 27

I'll guess you might have...rolled over...in your sleep. Can you make a pillow fort or something similar to make sure you stay on your back to prevent painful leverage from being exerted on your member?
posted by Dmenet at 2:18 PM on June 27

Dmenet, I'm guessing the pain for anon is coming from length (of time, you filthy pikers) and intensity of the erection, not...er... bending.
posted by dirtynumbangelboy at 2:49 PM on June 27

Ahhhh... you do not say if you've told your doctor about this. I strongly recommend you do so, 'cause the priapism (rarely) caused by trazodone is serious business. As in some absurd percentage of people who exhibit the symptom require surgical correction. Yeah, they have to bleed out your pee pee. And a minority but significant percentage of those have permanent damage.

Don't mess around if you're getting priapism from trazodone.
posted by Justinian at 3:37 PM on June 27

I could go off the trazodone, but actually if I was forced to choose, I think I would rather sleep this well than maintain a functioning penis.

You need to reconsider this.
posted by Inspector.Gadget at 4:07 PM on June 27

Seroquel (quetiapine) is (scroll down to side effects) a very bad idea. Especially when priapism is listed as a rare (1 in 1000 to 1 in 10,000) side effect. I've been taking quetiapine for years; it's just not something I would associate with restful sleep. It’s quite the opposite. You want to hallucinate for six hours, take a low dose of quetiapine.

For someone who avoids benzos, zopiclone is fairly inoffensive.

Speak to your consultant.
posted by hciadt at 5:09 PM on June 27

Good grief. What ever happened to good old BENADRYL/diphenhydramine hydrochloride? It makes me fall asleep and stay asleep without that particular side effect (of course I'm female, so ymmv). Seriously, I was thinking that I needed a serious sleep aid, but tried the benadryl first, and ta-da!
posted by Sassyfras at 5:25 PM on June 27

sassyfras: if you have chronic sleep issues, benadryl does not work. Or, I should say, a healthy dose no longer works if you have to take it several nights in a row. At some point, you start taking half a box to a whole box (I guess that's like 12 - 24 pills?) and still no sleep. Then the scale tips in the other direction and instead of sleeping, or simply not sleeping, you become agitated, jittery and awake, but not functional. It is not fun nor is it effective (or healthy, and yes I know consuming that much benedryl at once is seriously dangerous, no I don't do this anymore).

If you have insomnia every once in a while and benedryl works for you when you use it, consider yourself lucky. When you have severe insomnia, you stop thinking about benedryl as a sleep aid, and consider it just an antihistamine!
posted by necessitas at 7:09 PM on June 27 [1 favorite has favorites]

I'll guess you might have...rolled over...in your sleep. Can you make a pillow fort or something similar to make sure you stay on your back to prevent painful leverage from being exerted on your member?

Priapism can, if sustained long enough, cause serious damage to the penis. The poster is quite right to be concerned, and it isn't a matter of 'rolling over.'
posted by rodgerd at 2:58 AM on June 28

I have chronic insomnia. I take benadryl. 1-2 tablets before I go to bed. I have been doing this for years. It has not escalated beyond the 2 tablets EVER. I did not take my benadryl last night and woke up at 11:55 pm (after hitting the hay at 10 pm) and have been up ever since. It is now 6:42 am.

I am sorry it did not work for you necessitas. It has worked (and continues to work) for me and that is why I suggested it.
posted by Sassyfras at 3:44 AM on June 28

I'm glad it works for you sassyfras. I wasn't doubting the extent of your sleep disorder. You are lucky it does work for you. It does not work for me. It did for a while. It does if I haven't taken it for months, it's not a daily solution for me. I'm going to go out on a limb and assume that the OP probably tried all sorts of things before prescription options, and would not be so worried about having to choose between painful sleep time erections and sleepless nights w/o trazodone if benedryl was the solution.
posted by necessitas at 3:22 PM on June 28

I'm going to second a lot of the advice here.

1. Priapism is very serious. If you have the slightest bit of concern regarding it, stop the Trazodone immediately. Your penis will appreciate it.

2. Seconding Benadryl. I take 3 x 25mg tablets a night, and have been doing so for several years. It doesn't knock me out, but it helps me get the minimum amount of sleep necessary to keep from going insane. Tolerance is fairly minimal.

3. Seroquel is a terrible solution for insomnia. Do not take an antipsychotic unless you need an antipsychotic. They are not drugs to play around with. Besides, the hypnotic effects of Seroquel are mediated via… wait for it… antagonism of H₁ histamine receptors. Hey, just like Benadryl!

4. Another drug with strong H₁ antagonism is the atypical antidepressant mirtazapine (Remeron). Its antihistaminergic effects are insane. As in barbiturate-strength sedation. You will sleep like a baby in a coma under cryogenic suspension. Only downside: most people gain about 20lbs a year on it.

5. The so-called Z-drugs (zolpidem, zopiclone, et al) are reported to have less risk of tolerance than benzodiazepines, but that’s not saying much. Practically speaking, the vast majority of people won’t be able to take them more than a few nights in a row before they lose effectiveness. I take zolpidem two non-consecutive nights a week, because I’ve found this to be the greatest frequency I can maintain in a long-term regimen and still derive some benefit. Even then, it’s not as effective (or fun, unfortunately) as it was when I first started it a few years ago.

6. You can give valerian root or melatonin supplements a shot, but don’t be surprised when they don’t work. Same goes for Rozerem, actually.

Requisite boring advice: limit alcohol and caffeine consumption, exercise, make sure you have a good mattress, etc.
posted by dephlogisticated at 10:48 PM on July 6