Sexual Dysfunction as a Side Effect of Hyperprolactinemia in Methadone Maintenance Therapy

Abstract

A lthough endocrine abnormalities are recognized in opiate users, very little is known about the range of hormones affected, their pathophysiology and their clinical relevance. Various endocrine abnormalities have been reported in these patients including, increased prolactin levels and abnormalities in sexual hormone. Path physiological mechanism postulated does explain these findings including direct action of heroin or methadone at the hypothalamic pituitary level. The aim of this study was to explore the effects of heroin and methadone maintenance treatment on the plasma prolactin levels and sexual function. Material and methods: We evaluated 20 male narcotic addicts maintained of methadone more than 3 years on oral high dose methadone 60-120 mgr/day. Patients taking neuroleptic therapy were excluded from the study because neuroleptic-included hyperprolactinemia. We also evaluated group of twenty male heroin addicts on the street heroin .The prolactin plasma levels were assayed using the chemiluminescent immunometric essay (CLIA) -high sensitive methods, The normal range of prolactin levels was 1,5-17 ng/ml(53-360 nmol/l) for men and 1,90-25,0 ng/ml for women. The sexual function was assessed using a Questionnaire: International Index of Erectile Function (IIEF) with 15 items in four levels of sexual function. The differences between two examination groups were determined by a student' s t test. The results show that street heroin addicts (55% of them have high level of prolactin) have significantly higher plasma prolactin levels (p=0,006) then the group of methadone maintenance patients (only 15% of them have high prolactin level). In our study, when we compared sexual dysfunction in examination groups in some domains, we did not find statistical significant results (sexual desire p=0,52 and overall satisfaction p=0,087). But in domains of erectile function p=0,011 and orgasm function p=0,033 we got statistical significant results.

Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates

“…As indicated by previous findings, the exposure to heroin was thought to exert a depletion effect on testosterone and follicle stimulating hormone levels in just about all the groups studied irrespective of age, amount of heroin intake per day and period of contact with heroin [54] . Similarly, plasma levels of free testosterone were reported to be significantly low [55] and PRL levels significantly high [11,56] in heroin addicts. Lower levels of testosterone and higher levels of PRL were found among methadone patients also in our study, in comparison with healthy controls, but hormonal values did not correlate with methadone dosages, once again suggesting a more complex mechanism underlying the neuroendocrine changes.…”

“…Accordingly, in men seeking treatment for opioid dependence, the prevalence of sexual dysfunction was significantly higher in comparison with healthy control subjects [8] . In association with the clinical evidence of sexual dysfunction, impaired hypothalamus-pituitary-gonadal (HPG) axis and increased prolactin (PRL) levels have been found in patients exposed to long-lasting opioid receptor stimulation [5,[9][10][11] .…”

Readiness and recovery: Transferring between methadone and buprenorphine/naloxone for the treatment of opioid use disorder

“…; Trajanovska et al . ). Buprenorphine/naloxone appears to have less of an effect on the endocrine system when compared to methadone and other long‐acting full‐agonist opioids (Rapeli et al .…”

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

“…verapamil, methyldopa) and opiates (i.e. tramadol, buprenorphine, methadone) can also cause moderate elevations of serum PRL concentrations (45,46,47,48). The drugs are listed in Table 3.…”