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Author: Admin | 2025-04-28
IntroductionBuprenorphine/naloxone (Bup/Nal) is a semisynthetic opioid which was initially developed (Suboxone® [Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA]) as an analgesic which has been effectively in use for OMT since 2003 after approval by the Food and Drug Administration (FDA) in 2002.1,2 In Turkey Bup/Nal was introduced as the first OMT in 2010 since methadone was not legally available.Buprenorphine is a mu (µ) and a kappa (ƙ) partial agonist and an antagonist at the gamma (ɣ) opioid receptors possessing a greater margin of safety than conventional full agonists as well as yielding less severe withdrawal symptoms. Bup/Nal emerged in an attempt to reduce the addiction profile if injected or crushed by combining buprenorphine with naloxone in a 4/1 ratio.3,4 The maintenance dose of sublingual Bup/Nal ranges between 4/1 mg to 24/6 mg depending on the response of the patient, while the induction dose is initially between 4/1 mg to 8/2 mg with required increments at two-hour intervals.5 Recommended dose for Bup/Nal maintenance on average is 16/4 mg.6 Bup/Nal maintenance has mostly tolerable adverse effects including abdominal pain, constipation, changes in appetite, nausea, headaches, insomnia, anxiety, sweating, muscle pain.7 Opioid substitutes are also reported to cause loss of sexual desire and erectile dysfunction (ED).8,9 A wide range of sexual dysfunction rates, 14% to 81%, for the full µ opioid receptor agonist methadone, have been reported throughout different studies.10 Despite the widely reported sexual adverse effects of methadone maintenance treatment (MMT), data concerning Bup/Nal treatment is limited and controversial.11The results of the studies comparing the sexual adverse effects of buprenorphine maintenance treatment (BMT) and MMT were found to be controversial as well.10 Considering the limitations in some of these studies (eg, small sample sizes, lack of control group) there is a need to perceive more on the subject.12–14Erectile dysfunction (ED) is one of
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