Document Detail

Hemodynamic effects of methadone and dihydrocodeine in overdose.
MedLine Citation:
PMID:  17852162     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Opioid overdose is an increasing health problem worldwide. The cardiovascular toxicity of opioids contributes to morbidity and mortality in overdose but the hemodynamic effects of opioids reported in animal and human studies are contradictory. METHODS: We performed a prospective observational study of patients admitted to hospital following an overdose of methadone, dihydrocodeine, or low dose paracetamol (10 each). Basic cardiovascular indices including peripheral blood pressure, pulse rate, radial augmentation index and derived measures of aortic systolic, diastolic, pulse, and mean and end systolic pressures were measured every six hours for up to 18-23 hours after exposure or until hospital discharge. RESULTS: Dihydrocodeine and methadone significantly reduced peripheral and aortic systolic, mean and end systolic pressures. Both opioids significantly decreased peripheral pulse pressure, but only methadone decreased aortic blood pressure. Dihydrocodeine reduced systemic and aortic diastolic blood pressure, an effect not induced by methadone. Methadone significantly reduced peripheral pulse pressure. Augmentation index and heart rate, however, did not change. Both opioids decreased arterial oxygen saturation. CONCLUSION: These results suggest that dihydrocodeine and methadone in overdose both have a significant effect on central and peripheral hemodynamics. These effects might be expected to reduce cardiac afterload, providing a pharmacological explanation for the apparent benefit of opioids in cardiovascular diseases.
R Afshari; S R J Maxwell; D N Bateman
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  45     ISSN:  1556-3650     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:    2007 Oct-Nov
Date Detail:
Created Date:  2007-12-13     Completed Date:  2008-01-03     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  763-72     Citation Subset:  AIM; IM    
Medical Toxicology Centre, Imam Reza (P) Hospital, Mashhad, Iran.
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MeSH Terms
Acetaminophen / poisoning
Analgesics, Opioid / poisoning*
Blood Pressure / drug effects
Codeine / analogs & derivatives*,  poisoning
Hemodynamics / drug effects*
Methadone / poisoning*
Middle Aged
Oxygen / blood
Prospective Studies
Reg. No./Substance:
0/Analgesics, Opioid; 103-90-2/Acetaminophen; 125-28-0/dihydrocodeine; 76-57-3/Codeine; 76-99-3/Methadone; 7782-44-7/Oxygen

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