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Originalarbeit

Sexuelle Funktionsstörungen bei Substitution mit Methadon und Levomethadon

Published Online:October 21, 2016https://doi.org/10.1024/0939-5911/a000447

Abstract

Zusammenfassung.Hintergrund: Sexuelle Funktionsstörungen sind bei der Substitutionsbehandlung der chronischen Opioidabhängigkeit häufig. Neben Methadon ist Levomethadon derzeit die in Deutschland am häufigsten eingesetzte Substanz zur Substitution. Bisher gibt es unserer Kenntnis nach keine Studie, die sexuelle Funktionsstörungen bei Methadon im Vergleich zu Levomethadon untersucht hat. Zielsetzung: Erfragung von sexuellen Funktionsstörungen. Material und Methoden: Wir führten eine Befragung von männlichen opioidabhängigen Patienten unter Substitutionsbehandlung mit Methadon oder Levomethadon in Berlin durch. Sexuelle Funktionsstörungen wurden mit dem International Index of Erectile Function (IIEF) sowie in der Selbsteinschätzung erhoben. Ergebnisse: Es nahmen 66 Patienten an der Erhebung teil. 30 (45.5 %) erhielten Methadon, 36 (54.5 %) Levomethadon. Erektile Dysfunktion trat signifikant häufiger unter Methadon auf (p = .029). Bezüglich der Selbsteinschätzung sexueller Funktionsstörungen wiesen die Patienten, die über solche berichteten (N = 40, 71.4 %), eine signifikant höhere Dosierung der substituierten Substanz auf (p = .014; Dosierung 125 mg ± 45.3 mg vs. 93.3 mg ± 24.7 mg). Schlussfolgerung: Unsere Studie weist auf eine Überlegenheit von Levomethadon bzgl. der durch die Patienten selbst berichteten erektilen Funktion hin. Bei Auftreten von sexuellen Funktionsstörungen könnten ein Substanzwechsel oder eine Dosisreduktion hilfreich sein.


Sexual dysfunction related to opioid maintenance treatment with methadone and levomethadone

Abstract.Background: Sexual dysfunction is a common side effect in opioid maintenance treatment (OMT). Apart from methadone, in Germany levomethadone is the most often prescribed substance for OMT. Despite the high clinical relevance of these side effects, to our knowledge no study has investigated the influence of methadone compared to that of levomethadone on sexual function. Objectives: To collect data on sexual dysfunction with a standardized questionnaire and self-evaluation. Material and Methods: We conducted a study with chronically affected opioid dependent male patients currently receiving OMT with methadone and levomethadone in Berlin. We used the International Index of Erectile Function (IIEF) as well as self-ratings. Results: 66 patients took part, 30 (45.5 %) in the methadone, 36 (54.5 %) in the levomethadone group. Erectile dysfunction occurred significantly more often in the methadone group (p = .029). Patients reporting sexual desire (N = 40, 71.4 %) in self-ratings received a significantly higher dosing of OMT (p = .014, 125 mg ± 45.3 mg vs. 93.3 mg ± 24.7 mg). Conclusions: Our study hints to a superiority of levomethadone over methadone concerning self-reported erectile function. If sexual dysfunction is present in a subject being treated with OMT, a switch to levomethadone or an overall reduction of the dosage could be helpful.

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