Document Detail

Torsade de pointes associated with very-high-dose methadone.
MedLine Citation:
PMID:  12230351     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Methadone is an effective treatment for opioid dependency and chronic pain. A methadone derivative, levacetylmethadol, was withdrawn from the European market after being associated with torsade de pointes. To date, no association between methadone and this arrhythmia has been described. OBJECTIVE: To evaluate a series of methadone-treated patients experiencing torsade de pointes. DESIGN: Retrospective case series. SETTING: Methadone maintenance treatment programs in the United States and a pain management center in Canada. PATIENTS: 17 methadone-treated patients who developed torsade de pointes. MEASUREMENTS: Chart review for concomitant arrhythmia risk factors and quantification of corrected QT interval (QTc). RESULTS: The mean daily methadone dose was 397 +/- 283 mg, and the mean QTc interval was 615 +/- 77 msec. Fourteen patients had a predisposing risk factor for arrhythmia. A cardiac defibrillator or pacemaker was placed in 14 patients; all 17 patients survived. CONCLUSIONS: This series raises concern that very-high-dose methadone may be associated with torsade de pointes. Given the likely expansion of methadone treatment into primary care, further investigation of these findings is warranted.
Mori J Krantz; Laurent Lewkowiez; Helen Hays; Mary Ann Woodroffe; Alastair D Robertson; Philip S Mehler
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  137     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-16     Completed Date:  2002-09-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  501-4     Citation Subset:  AIM; IM    
Denver Health Medical Center, and The University of Colorado Health Sciences Center, Bannock Street, Mailcode 0960, Denver, CO 80204-4507, USA.
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MeSH Terms
Analgesics, Opioid / administration & dosage,  adverse effects*
Chronic Disease
Heroin Dependence / rehabilitation
Methadone / administration & dosage,  adverse effects*
Middle Aged
Pain / drug therapy
Retrospective Studies
Risk Factors
Torsades de Pointes / chemically induced*,  diagnosis
United States
Reg. No./Substance:
0/Analgesics, Opioid; 76-99-3/Methadone
Comment In:
Ann Intern Med. 2003 Jul 15;139(2):E156   [PMID:  12859181 ]
Ann Intern Med. 2003 Aug 19;139(4):W64   [PMID:  12966001 ]
Ann Intern Med. 2003 Aug 19;139(4):W64   [PMID:  12966000 ]
Summary for patients in:
Ann Intern Med. 2002 Sep 17;137(6):I42   [PMID:  12230382 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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