1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-18-51 10.15844/pedneurbriefs-18-7-3 Attention Deficit Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Priapism Associated with MethylphenidateSR (Concerta) Withdrawal http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 07 2004 01 03 2016 18 7 51 52 Copyright: © 2004 The Author(s) 2004 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Stuttering priapism associated with withdrawal from sustained-release methylphenidate

A 15-year-old boy with attention deficit hyperactivity disorder, inattention subtype (ADHD), developed stuttering priapism (intermittent, prolonged, painful erections) after withdrawal of OROS methylphenidate (ConcertaR) 36 mg/day, and is reported from Inova Fairfax Hospital for Children, Falls Church, VA, and Children’s National Medical Center, Washington, DC.

 Morning Dose Symptoms Erections

A 15-year-old boy with attention deficit hyperactivity disorder, inattention subtype (ADHD), developed stuttering priapism (intermittent, prolonged, painful erections) after withdrawal of OROS methylphenidate (ConcertaR) 36 mg/day, and is reported from Inova Fairfax Hospital for Children, Falls Church, VA, and Children’s National Medical Center, Washington, DC. Symptoms began after the dose was increased from 27 mg/day to 36 mg/day, 6 days per week, with scheduled withdrawal on Sundays. Symptoms were exacerbated when a dose of 54 mg/day was prescribed later. An estimated 5 to 10 painful erections occurred on the first Sunday after one week of treatment, and each lasted 10 to 15 minutes or sometimes longer. On the following weekdays, erections recurred early AM on the school bus but stopped suddenly within 1 hour after taking the morning dose, only to return the following morning. After reducing the dose to 27 mg/day and gradually discontinuing treatment completely, symptoms immediately disappeared, with no recurrence of priapism at 6 months follow-up. Urinalysis for other drugs was negative. [1]

COMMENT. Priapism has been reported with sickle-cell hemoglobinopathy in children, but not with stimulant drugs. In the present case, the problem was not initially disclosed because of embarrassment, and further undiagnosed cases are possibly occurring.

Schwartz RH Rushton HG Stuttering priapism associated with withdrawal from sustained-release methylphenidate J Pediatr 2004 May 144 5 675 6 10.1016/j.jpeds.2003.12.039 15127013