Mori J. Krantz, MD; Judith Martin, MD; Barry Stimmel, MD; Davendra Mehta, MD; Mark C.P. Haigney, MD
An independent panel developed cardiac safety recommendations for physicians prescribing methadone.
Expert panel members reviewed and discussed the following sources regarding methadone: pertinent English-language literature identified from MEDLINE and EMBASE searches (1966 to June 2008), national substance abuse guidelines from the United States and other countries, information from regulatory authorities, and physician awareness of adverse cardiac effects.
Clinicians should inform patients of arrhythmia risk when they prescribe methadone.
Clinicians should ask patients about any history of structural heart disease, arrhythmia, and syncope.
Obtain a pretreatment electrocardiogram for all patients to measure the QTc interval and a follow-up electrocardiogram within 30 days and annually. Additional electrocardiography is recommended if the methadone dosage exceeds 100 mg/d or if patients have unexplained syncope or seizures.
If the QTc interval is greater than 450 ms but less than 500 ms, discuss the potential risks and benefits with patients and monitor them more frequently. If the QTc interval exceeds 500 ms, consider discontinuing or reducing the methadone dose; eliminating contributing factors, such as drugs that promote hypokalemia; or using an alternative therapy.
Clinicians should be aware of interactions between methadone and other drugs that possess QT intervalâ€“prolonging properties or slow the elimination of methadone.
Editor's Note: Some members of an expert panel proposed the recommendations presented in this publication. Two panel members declined acknowledgment for the publication. This publication is not a federal guideline. A government agency has recently forwarded draft recommendations related to QTc interval screening in methadone treatment for field review prior to finalization.
CSAT = Center for Substance Abuse and Treatment; QTc = rate- corrected QT interval.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc Interval Screening in Methadone Treatment. Ann Intern Med. 2009;150:387–395. doi: 10.7326/0003-4819-150-6-200903170-00103
Download citation file:
Published: Ann Intern Med. 2009;150(6):387-395.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use