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Clinical evidence

Trazodone

SARI antidepressant·Medication side-effects · Sexual-dysfunction treatments
⚠ Critical

Can cause priapism (a prolonged, painful erection). This is a medical emergency — untreated it risks permanent damage.

Effect across the cycle

DesireMixed: Variable; generally less suppressive than SSRIs.
ArousalFacilitatory: Low-dose pro-erectile effect reported historically.
PerformanceBiphasic: Pro-erectile at low dose but carries priapism risk.
ClimaxMixed: Less orgasmic impairment than SSRIs.
ExperienceNeutral: Sedation is the main subjective effect.
MemoryNeutral: Not a memory factor.

Mechanism

Antagonizes 5-HT2A, H1 and alpha-1 adrenergic receptors. Alpha-1 blockade in penile tissue, without counterbalancing anticholinergic activity, causes priapism — trazodone is the prescription drug most commonly associated with ischemic priapism. Historically used off-label at low doses as a pro-erectile agent.

Pharmacokinetics
Sedating; low doses used for sleep and off-label for erectile support.
Reversibility
Priapism is a urological emergency requiring immediate care.

Sex differences & notes

Lower rate of sexual dysfunction than SSRIs.

Key sources

  • Abber et al., J Urol 1987 (canine intracorporeal model)