Does Sublocade cause erectile dysfunction? Prolonged-release buprenorphine injections, such as Buvidal (the UK equivalent of Sublocade), are effective treatments for opioid dependence, but sexual dysfunction including erectile dysfunction is a recognised potential side effect. Like other opioid medications, buprenorphine can affect hormone levels and sexual function through suppression of the hypothalamic-pituitary-gonadal axis, leading to reduced testosterone production. However, individual experiences vary considerably, and not all patients will experience these effects. This article explores the mechanisms behind opioid-related erectile dysfunction, practical management strategies, and when to seek medical advice whilst maintaining your recovery treatment.

What Is Prolonged-Release Buprenorphine Injection and How Does It Work?

Prolonged-release buprenorphine injection (available in the UK as Buvidal) is a long-acting formulation of buprenorphine used in the treatment of opioid dependence. Unlike daily sublingual buprenorphine tablets or films, these injections are administered weekly or monthly by healthcare professionals, providing sustained therapeutic levels of the medication over an extended period.

Buprenorphine works by binding to opioid receptors in the brain, particularly the mu-opioid receptor. As a partial agonist, it produces a ceiling effect—meaning that beyond a certain dose, increasing the amount does not produce additional opioid effects. This characteristic makes buprenorphine safer than full opioid agonists, with a lower risk of respiratory depression and overdose. The medication helps to reduce cravings and withdrawal symptoms, allowing individuals to focus on recovery and rehabilitation.

The extended-release formulation uses specific technology that gradually releases buprenorphine into the bloodstream. Following injection, the medication forms a depot beneath the skin, which slowly dissolves over time. Steady-state plasma concentrations typically take several months to achieve with monthly formulations, providing more consistent symptom control compared to the peaks and troughs associated with daily dosing.

Before starting prolonged-release buprenorphine, patients must be stabilised on sublingual buprenorphine, with specific requirements varying between products (refer to the relevant Summary of Product Characteristics). These medications are prescribed as part of a comprehensive treatment programme that includes counselling and psychosocial support, in accordance with NICE guidance and UK clinical guidelines on managing opioid dependence.

Why Opioid Medications May Affect Sexual Function

Sexual dysfunction, including erectile dysfunction (ED), is a recognised adverse effect associated with opioid medications, whether used therapeutically or recreationally. The mechanisms underlying opioid-induced sexual dysfunction are multifactorial and involve both direct pharmacological effects and indirect hormonal changes. Understanding these mechanisms is important for patients receiving opioid-based treatments such as prolonged-release buprenorphine.

Hormonal disruption is one of the primary pathways through which opioids affect sexual function. Chronic opioid use can suppress the hypothalamic-pituitary-gonadal (HPG) axis, leading to reduced production of gonadotropin-releasing hormone (GnRH). This suppression results in decreased levels of luteinising hormone (LH) and follicle-stimulating hormone (FSH), which in turn reduces testosterone production in men. Low testosterone levels are strongly associated with reduced libido, erectile dysfunction, and other sexual health problems.

Buprenorphine, despite being a partial opioid agonist, can still affect the HPG axis, though potentially to a lesser degree than full opioid agonists such as methadone or morphine. The impact on testosterone levels may vary between individuals and may be dose-dependent. Sexual dysfunction, including decreased libido and erectile dysfunction, is listed in the Summary of Product Characteristics for buprenorphine products.

Direct neurological effects also play a role. Opioid receptors are present throughout the central and peripheral nervous systems, including areas involved in sexual arousal and response. Activation of these receptors can interfere with the complex neurovascular processes required for achieving and maintaining an erection.

It's important to note that erectile dysfunction is often multifactorial. Other common contributors include cardiovascular disease, diabetes, other medications (such as antidepressants, antipsychotics, or beta-blockers), alcohol consumption, smoking, and psychological factors such as depression, anxiety, and stress associated with opioid dependence and recovery. Individual experiences vary considerably, and not all patients will experience sexual side effects during treatment.

Managing Sexual Side Effects During Treatment

If you experience erectile dysfunction or other sexual side effects whilst receiving prolonged-release buprenorphine treatment, there are several management strategies that may help. It is essential to maintain open communication with your healthcare team, as sexual health is an important component of overall wellbeing and quality of life during recovery.

Lifestyle modifications can have a significant positive impact on sexual function. Regular physical exercise improves cardiovascular health, which is crucial for erectile function, and can also help to naturally boost testosterone levels. Maintaining a healthy body weight, eating a balanced diet, reducing alcohol consumption, and stopping smoking are all evidence-based interventions that support sexual health. Adequate sleep and stress management techniques, such as mindfulness or cognitive behavioural therapy, may also be beneficial.

Medical assessment and monitoring are important steps. Your GP or addiction specialist may recommend blood tests to check hormone levels, including morning total testosterone measurements on two separate occasions, as well as LH, FSH, and possibly prolactin levels. If hypogonadism (low testosterone) is confirmed, testosterone replacement therapy may be considered in selected cases, though this decision requires careful evaluation of risks and benefits, including monitoring of haematocrit and PSA (where appropriate). Testosterone replacement is not suitable for everyone and requires specialist assessment.

Pharmacological options for erectile dysfunction, such as phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, tadalafil), may be appropriate for some patients. Most require a prescription, though sildenafil 50mg (Viagra Connect) can be supplied by pharmacists after assessment. These medications work by enhancing blood flow to the penis but are contraindicated in patients taking nitrates or riociguat and should be used with caution in those taking alpha-blockers or with unstable cardiovascular disease. Never purchase ED medicines from unregulated online sources.

Psychological support should not be overlooked. Sexual dysfunction can have psychological causes or consequences, including performance anxiety, relationship difficulties, or depression. Access to counselling, sex therapy, or couples therapy may be valuable. Many substance misuse services offer integrated psychological support as part of comprehensive care. Remember that recovery from opioid dependence is a process, and sexual function may improve naturally over time as overall health and wellbeing improve.

When to Speak to Your Doctor About Erectile Dysfunction

It is important to discuss erectile dysfunction with your doctor if it is causing you distress, affecting your relationships, or impacting your quality of life. Sexual health is a legitimate medical concern, and healthcare professionals are accustomed to discussing these issues in a confidential and non-judgemental manner. Early discussion can help identify underlying causes and appropriate management options.

You should contact your GP or addiction specialist if:

• Erectile dysfunction develops or worsens after starting buprenorphine treatment

• Sexual side effects are affecting your adherence to treatment or your motivation to continue recovery

• You experience other symptoms that may indicate hormonal imbalance, such as reduced libido, fatigue, mood changes, or loss of muscle mass

• You have concerns about the impact of your medication on your sexual health or relationships

• You are considering stopping or reducing your medication due to sexual side effects—never alter your treatment without medical guidance

Seek urgent medical attention if:

• You experience chest pain or severe shortness of breath during sexual activity (call 999)

• You have an erection lasting more than 4 hours (priapism), which requires emergency treatment

• You develop sudden severe pain in the penis or testicles

Your doctor will typically take a comprehensive history, including details about the onset and nature of the erectile dysfunction, other medications you are taking, and relevant medical conditions such as diabetes, cardiovascular disease, or mental health disorders. Physical examination and blood tests may be arranged to assess hormone levels, cardiovascular risk factors, and other potential contributing factors. A cardiovascular risk assessment is often recommended, as erectile dysfunction can be an early indicator of cardiovascular disease.

It is crucial to continue your buprenorphine treatment as prescribed whilst these issues are being addressed. Stopping opioid substitution therapy abruptly can lead to relapse, withdrawal symptoms, and serious health risks. Your healthcare team can work with you to find solutions that support both your recovery from opioid dependence and your sexual health.

Remember that erectile dysfunction is a common issue affecting many men for various reasons, and effective treatments are available. If you suspect your medication is causing side effects, you can report this through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk). Addressing sexual health concerns is an important part of holistic care during addiction treatment and recovery, and seeking help is a positive step towards improving your overall wellbeing.

Frequently Asked Questions