Mori J. Krantz, MD; Laurent Lewkowiez, MD; Helen Hays, MD; Mary Ann Woodroffe, BScN; Alastair D. Robertson, PhD; Philip S. Mehler, MD
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Torsade de Pointes Associated with Very-High-Dose Methadone. Ann Intern Med. 2002;137:501-504. doi: 10.7326/0003-4819-137-6-200209170-00010
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Published: Ann Intern Med. 2002;137(6):501-504.
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 A methadone derivative, levacetylmethadol, was withdrawn from the European market after being associated with torsade de pointes.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.
To evaluate a series of methadone-treated patients experiencing torsade de pointes.
Retrospective case series.
Methadone maintenance treatment programs in the United States and a pain management center in Canada.
17 methadone-treated patients who developed torsade de pointes.
Chart review for concomitant arrhythmia risk factors and quantification of corrected QT interval (QTc).
The mean daily methadone dose was 397 Â± 283 mg, and the mean QTc interval was 615 Â± 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.
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.
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Cardiology, Rhythm Disorders and Devices.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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