Polypharmacy Leading to Priapism in HIV Patient withSchizoaffective Disorder: A CYP450 Cascade

With increasing trend of polypharmacy, there are higher chances of drug-drug interactions leading to adverse effects, especiallyin psychiatric patients with co-morbid chronic medical problems. This case demonstrates a schizoaffective 30-year-old male onhighly active antiretroviral therapy (HAART) who reported an incident of priapism potentially caused by an interaction betweenpreviously prescribed atypical antipsychotic, trazodone, norepinephrine dopamine reuptake inhibitor (NDRI), HAART, and newlyadded selective serotonin reuptake inhibitor (SSRI). This case emphasizes obtaining careful medication history, understandingcytochrome P450 (CYP450) enzyme and its subtypes, and discouraging polypharmacy. Clinicians must educate their patients aboutdifferent sexual side effects as these can be socially stigmatizing and can further deteriorate mental health symptoms