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Life Science Journal 2013;10(9s) http://www.lifesciencesite.com Bupropion in Methadone Induced Erectile Dysfunction
Faeze Tatari, MD 1, Jalal Shakeri, MD 2, Vahid Farnia, MD 3,*, Farid Heidari, MD 4, Mansour Rezaei, MD 5 1. Assistant professor, Behavioral Sciences Research Center, Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran, [email protected] 2. Associate professor. Behavioral Sciences Research Center, Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran, [email protected] 3. Assistant professor, Behavioral Sciences Research Center, Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran, email: [email protected] 4. Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran, 5. Department of Statistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran, *Corresponding author: Assistant professor, Behavioral Sciences Research Center, Psychiatry Department,
Kermanshah University of Medical Sciences, Kermanshah, Iran Tel: +98-831-826700, Fax: +98- 831-8264163, E-mail: [email protected]
Abstract: Background: Use of opioids is associated with hypoactive sexual desire, erectile and orgasmic
dysfunction. 16-30% of patients in methadone-maintained Therapy (MMT) may develop erectile dysfunction (ED).
Objective: To evaluate the efficacy of Bupropion (an antidepressant which can improve sexual function) in
treatment of Methadone induced sexual dysfunction. Method: Patients recruited from 3 Methadone clinic in
Kermanshah underwent a structured clinical interview according to DSM-IV-TR. Erectile function was assessed
using erectile dysfunction intensity scale. From the 72 subjects, 67 suffered from ED. The subjects were informed
about the study and then, 67 patients voluntarily received 100mg of Bupropion for six weeks. 52 patients who
completed the treatment course were assessed by ED questionnaire at the end of the study. Statistical analysis was
performed using SPSS-16 software. Results: The prevalence of ED was 93.0% in our sample. The mean erectile
dysfunction (ED) intensity scale was 12.79, and 15.94 before and after the treatment course respectively (P=0.03).
ED severity had no significant relation with age and type of substance dependency (P=0.09); but it had a significant
relation with duration and dosage of Methadone therapy (p<0.05). No major side effects were observed in our
sample durig treatment course. This trial is registered with the Iranian Clinical Trials Registry
(IRCT138905124501N1; www.irct.ir). Conclusion: We find that Bupropion may be effective in the treatment of
methadone induced ED. Further studies with control group and greater sample size are warranted to evaluate the
efficacy of this medication in Methadone Induced Erectile Dysfunction.
[Faeze Tatari, Jalal Shakeri, Vahid Farnia, Farid Heidari, Mansour Rezaei. Bupropion in Methadone Induced Erectile
Dysfunction. Life Sci J 2013;10(9s):330-332] (ISSN:1097-8135). http://www.lifesciencesite.com. 46
Keywords: Erectile dysfunction, Methadone, Bupropion

Introduction
Previous studies reported the prevalence and improve adherence to treatment, the effectiveness of types of sexual dysfunction in men on methadone which, as is well-known, is associated with high maintenance for opioid dependence, and describe factors which may contribute to sexual dysfunction. There are various treatment options for ED, although men strongly prefer oral therapies [10]. threatening, it may result in withdrawal from sexual Bupropion is a second generation antidepressant intimacy and reduced quality of life [1, 2, 3]. agent that blocks centrally the reuptake of Estimates of the prevalence of ED in methadone- noradrenaline and dopamine [11]. It is an oral maintained patients vary widely: 16% [4], 23% antidepressant which is commonly used adjunctively (21/92) [5], 30% (8/27) [6].Many patients with ED to treat selective serotonine reuptake inhibitor fail to mention ED to clinicians and counselors [7] induced sexual dysfunction and sexual dysfunction in non depressed patients and has a positive effect on uncomfortable and embarrassed about dealing with sexual function [12, 13]. This agent also reported to sexual problems[8]. Nevertheless, the assessment of be useful in improvement of orgasmic delay and ED in these patients may be quite important. inhibition, and possibly disorders of sexual arousal in Life Science Journal 2013;10(9s) http://www.lifesciencesite.com non depressed patients [14]. ED is an important side course. The subjects were 21–53 years old (mean age effect of Methadone therapy and to our knowledge =36.2± 11.2 year). 15 patients dropped out, and only one prior study was done in treatment of this disorder. We conducted this study to evaluate the dysfunction (ED) intensity scale increased from efficacy of this drug on methadone induced ED. 12.79 to 15.94 in patients after the treatment course (P=0.03). No significant relation was found between Materials and Method
age and ED. (P=0.07). History of substance One hundred thirty two patients were studied dependency indicated 40.6% dependency to opium, from May 2010 to January 2012. Three enters 37.5% to heroin, and others showed poly substance recruited patients every day, from 3 Methadone dependency. No significant association was observed clinics of Kermanshah University of Medical between type of substance dependency and ED. Sciences (KUMS). The inclusion criteria were: being married male; 18 years of age or older; having a There was a significant association between history of opium dependence; and having been on methadone treatment for at least 30 days. A physician (P=0.01). Also relationship between daily Methadone visited all patients and whom with obvious organic dosage and ED severity was statistically significant illnesses (such as diabetics or patients with heart and (P=0.04). No major side effect was detected during vascular disease), patients under treatment with any treatment course in our participants. No major side other medications and those with history of ED effects were observed in our sample by using the before Methadone therapy was excluded. Written and signed informed consent was obtained from the participants. Participation in the study was voluntary Discussion
and confidential. No remuneration was provided for According our study results 93.0% of patients participation. The Trial was approved by the Local under Methadone therapy suffered from ED which Ethics Committee and is registered with the Iranian was congruent with the literature which reported high Clinical Trials Registry (IRCT138905124501N1; prevalence ED in these patients [4, 6, 7, 15,16]. Spring WD et al reported that sexual dysfunction A structured clinical interview according to among these patients may be due to coexisting DSM-IV-TR was administered by a psychiatrist for psychiatric problems rather than caused by opiates diagnosis of ED. The interview included questions on drug use and sexual behavior. Erectile function was a We showed significant association between assessed using erectile dysfunction (ED) intensity daily methadone dosage and severity of ED. Those scale [Total score: 5 to 10 (severe ED); 11 to 15 patients who received higher methadone dosage (moderate ED); 16 to 20 (mild ED); and 21 to 25 (no showed a more severe ED, and this may be due to ED)] which was used by Tatari et al in Iran adverse effects of methadone which reported in previously [15].The higher the score the lower the ED severity. After the interview, the patients completed the erectile dysfunction (ED) intensity Methadone therapy and ED severity was also scale. 72 subjects met the inclusion criteria; and of statistically significant. Those patients who were on them, 67 suffered from ED. After being informed Methadone therapy for a longer time, showed a more about the study, 67 patients voluntarily underwent severe ED than others. Chen W et al reported treatment with 100mg of Bupropion for 6 weeks.15 significantly association between erectile function patients dropped out because of irregular drug and duration of Methadone therapy. [18] No consumption. 52 patients who completed the significant association between age and ED was seen treatment course were assessed by the erectile dysfunction (ED) intensity scale and by clinical In this study, we found that Bupropion was interview again at the end of study. Statistical effective in the treatment of ED in patients who are analysis was done, using SPSS-16 software. under Methadone therapy. Bupropion increased the Associations between categorical risk factors and ED mean ED intensity scale, and may improve this scores and changes in the mean erectile dysfunction sexual dysfunction when induced by Methadone. (ED) intensity scale were tested by qi-square. Previous studies also showed the efficacy of Bupropion on sexual function in different samples [11-13]. One study reported efficacy of Trazodone in The study included 72 males. 67 patients suffered from ED (93.0%) and went under treatment Our study had some limitations. First we do with Bupropion 100mg daily for 6 weeks treatment not have a placebo control group. Second our stdy Life Science Journal 2013;10(9s) http://www.lifesciencesite.com sample size was relatively small. Third our subjects opiate addicts. Pharmacopsychiatry 1995; 28: were on short-term treatment period. Consequently the results should be interpreted with caution. 8. Risen CB. A guide to taking a sexual history. In summary, this study reports that Erectile Psychiatr Clin North Am 1995; 18: 39-53. dysfunction is likely to be an important problem for 9. Strain EC, Bigelow GE, Liebson IA, Stitzer many males who are under Methadone therapy which ML. Moderate- vs high-dose methadone in the needs assessment and treatment. Bupropion may be treatment of opioid dependence: a randomized effective in the treatment of methadone induced ED. Further studies with greater sample size, and control 10. Jarow JP, Nana-Sinkam P, Sabbagh M, Eskew group may determine the role of Bupropion in A. Outcome analysis of goal directed therapy for impotence. J Urol 1996; 155: 1609- 1612. This trial is registered with the Iranian Clinical 11. Atkinson JH, Slater MA, Wahlgren DR et al. Effects of noradrenergic and serotonergic antidepressants on chronic low back pain References
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