Sexual Health Supplement Leads to Priapism
SOURCE: Campanelli M, et al. Priapism caused by 'Tribulus terrestris'. Int J Impot Res 2015;28:39-40.
Were you to plug in “Tribulus terrestris supplement” into Google, numerous opportunities to purchase OTC supplements, within a wide range of affordability, would appear. It appears tribulus has some effects similar to PDE5 inhibitors (e.g., sildenafil) that would potentially enhance sexual function in males: enhancement of nitric oxide production in the endothelium of the corpora cavernosa, and cavernosal smooth muscle relaxation. Apparently, tribulus — also known as puncture vine or Gokhru — grows well in numerous countries around the world (especially China, India, the southern United States, and Spain), and has long been utilized by herbalists as a primary or contributing ingredient in herbal supplements.
Since OTC supplements lack FDA oversight and regulation, it should not be surprising that unanticipated adversities occur. Such misadventure may be attributed to mislabeled amounts of constituents, adulterants, idiosyncratic reactions, or may represent spontaneous events unrelated to ingestion of the supplements.
Campanelli et al reported a case of a young man with persistent priapism (duration = 72 hours) subsequent to 2 weeks of daily Tribulus terrestris supplementation. Invasive treatment (aspiration of corpus cavernosa and creation of a cavernoglandular shunt) was required for resolution, with restoration to nearly complete pre-morbid sexual function at 8 months follow-up.
This is not the first reported case of Tribulus terrestris associated with priapism. In addition to personal preferences, which often motivate patients to seek non-traditional treatments, the current high cost of FDA-approved pharmacologic treatments may motivate some individuals to seek much less expensive OTC remedies. If clinicians become aware of patient tribulus use, they should caution users about the potential for priapism and encourage patients to seek prompt consultation if a prolonged erection occurs.
In addition to personal preferences, which often motivate patients to seek non-traditional treatments, the current high cost of FDA-approved pharmacologic treatments may motivate some individuals to seek much less expensive OTC remedies.
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