Trazodone in Methandone Induced Erectile Dysfunction
Tatari, Faezeh, Farnia, Vahid, Nasiri, Reza Faghih, Najafi, Farid, Iranian Journal of Psychiatry
Objective: Based on findings of previous studies, those men on Methadone Maintenance Therapy (MMT) have a high prevalence of Erectile Dysfunction(ED), related to hypogonadism and depression. We conducted this study to evaluate the efficacy of Trazodone (an antidepressant which can improve sexual function) on this sexual dysfunction.
Method: A structured interview was administered by the clinical staff. The interview contained questions about the subjects' socio-demographic characteristics, their drug use and sexual behavior.
In addition to the socio-demographic survey, erectile function was assessed using erectile dysfunction (ED) intensity scale. Of the 157 subjects, 95 suffered from ED. The subjects were informed about the study. Then, seventy five patients voluntarily received 50mg of Trazodone for four days, and the dosage was increased to100 mg and maintained for 6 weeks. Fifty five patients who completed the treatment course were assessed by ED questionnaire again at the end of study. Statistical analysis was performed using Stata 8 software.
Results: The prevalence of ED was 60.5% in our sample. The mean erectile dysfunction (ED) intensity scale was 12.21, and 16.78 before and after the treatment course respectively. (P<0.05)
ED severity had no significant relation with age and type of substance dependency (P>0.05); but it had a significant relation with duration of Methadone therapy and Methadone daily dosage. (p<0.05)
Conclusion: Trazodone may be effective in the treatment of methadone induced ED. Further studies with control groups and greater sample sizes are warranted.
Keywords: Erectile dysfunction, Methadone, Trazodone,
Iran J Psychiatry 2010; 5:164-166
Erectile dysfunction (ED) is defined as 'the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance (1). While ED is not life threatening, it may result in withdrawal from sexual intimacy and reduced quality of life (2, 3). Estimates of the prevalence of ED in methadone-maintained patients vary widely: 16% (8 cases/50 subjects) (4), 23% (21/92) (5), 30% (8/27) (6), 33% (6/18) (7).
Many patients with ED fail to mention ED to clinicians and counselors (4) and many clinicians and counselors feel uncomfortable and embarrassed about dealing with sexual problems (8). Nevertheless, the assessment of ED in these patients may be quite important.
Identification and management of ED problems can improve adherence to treatment, the effectiveness of which, as is well-known, is associated with high doses and long treatment duration (9).
There are various treatment options for ED, although Men strongly prefer oral therapies (10). Trazodone hydrochloride is an oral antidepressant agent that also has anxiolytic and sedative/hypnotic effects. Because of reports of increased libido and sexual function associated with its use, Trazodone is also sometimes used to treat ED (11). Among oral treatments for ED, the selection of a specific agent may involve considering associated adverse effects and possible contraindications because of the patient's comorbidity or drug interactions. For these reasons among others, it is important for patients with ED to have a variety of available treatment options that are both effective and safe. Six trials (comprising 396 men) met the inclusion criteria. The trials consisted of heterogeneous populations, were small, brief and in some cases methodologically weak. Three of the six trials showed an apparently clinically meaningful benefit of Trazodone for ED compared with placebo, the differences being statistically significant in two (12).
The effect of Trazodone on erectile function may be related to its antagonism of α 2-adrenergic receptors (13). We conducted this study to evaluate the efficacy of this drug on methandone induced ED.
Materials and Method
One hundred fifty seven Patients were recruited from 3 methadone clinics of Kermanshah University of Medical Sciences. …