Prolonged QT interval and methadone: Implications for palliative care

Current Opinion in Supportive and Palliative Care

Volumn 3, Issue 4, 2009, Pages 252-257

  Wilcocka, Andrew ^a   Beattieb, James M ^b  

^a NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST   (United Kingdom)

^b BIRMINGHAM HEARTLANDS HOSPITAL   (United Kingdom)

Author keywords

Methadone; Palliative care; Prolonged QT interval

Indexed keywords

METHADONE; NARCOTIC AGENT;

ARTICLE; CHEMICALLY INDUCED DISORDER; FEMALE; HUMAN; LONG QT SYNDROME; MALE; PALLIATIVE THERAPY; PATIENT SELECTION; TORSADE DES POINTES;

FEMALE; HUMANS; LONG QT SYNDROME; MALE; METHADONE; NARCOTICS; PALLIATIVE CARE; PATIENT SELECTION; TORSADES DE POINTES;

EID: 74549198195     PISSN: 17514258     EISSN: 17514266     Source Type: Journal    
DOI: 10.1097/SPC.0b013e328332e0a4     Document Type: Article

References (20)

1. Yan GX, Lankipalli RS, Burke JF, et al. Ventricular repolarization components on the electrocardiogram: cellular basis and clinical significance. J Am Coll Cardiol 2003; 42:401-409.
2. Dessertenne F. Ventricular tachycardia with two variable opposing foci. Arch Mal Coeur Vaiss 1966; 59:263-272.
3. Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart 2003; 89:1363-1372.
4. Kannankeril PJ, Roden DM. Drug-induced long QT and torsade de pointes: recent advances. Curr Opin Cardiol 2007; 22:39-43.
5. Beattie JM. Sotalol induced torsade de pointes. Scott Med J 1984; 29:240-244.
6. Andrews CM, Krantz MJ, Wedam EF, et al. Methadone-induced mortality in the treatment of chronic pain: role of QT prolongation. Cardiol J 2009; 16:210-217.
7. Gaertner J, Voltz R, Ostgathe C. Methadone: a closer look at the controversy. J Pain Symptom Manage 2008; 36:e4-e7. An outline of differing properties of (R) and (S)-methadone.
8. Stringer J, Welsh C, Tommasello A. Methadone-associated QT interval prolongation and torsades de pointes. Am J Health-Syst Pharm 2009; 66:825-833. An excellent summary of the literature.
9. Shaiova L, Berger A, Blinderman CD, et al. Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care 2008; 6:165-176. An essential read for those using parenteral methadone in the USA.
10. Cruciani RA. Methadone: to ECG or not to ECG - that is still the question. J Pain Symptom Manage 2008; 36:545-552. A good summary of the evidence for and against ECG monitoring.
11. Department of Health and the devolved administrations. Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive; 2007.
12. Office of Alcoholism and Substance Abuse Services medical advisory panel position on QTc interval screening in methadone treatment; 2009. [Accessed from http://www.oasas.state.ny.us/Admed/cme/QTCinterval.cfm].
13. Krantz MJ, Martin J, Stimmel B, et al. QTc interval screening in methadone treatment. Ann Intern Med 2009; 150:387-395.
14. Gourevitch MN. First do no harm . . . reduction? Ann Intern Med 2009; 150:417-418.
15. American association for the treatment of opioid dependence, Inc. QTc interval screening: AATOD policy and guidance statement; 2009. [Accessed from http://www.aatod.org/qtc.html].
16. Burgess FW, Pawasauskas J. Methadone analgesia for persistent pain: safety and toxicity considerations. Med Health R I 2008; 91:273-275.
17. Gallagher R. Methadone: an effective, safe drug of first choice for pain management in frail older adults. Pain Med 2009; 10:319-326. A helpful series of cases illustrating the 'start-low, go-slow' use of methadone in the frail elderly.
18. Walker G, Wilcock A, Carey AM, et al. Prolongation of the QT interval in palliative care patients. J Pain Symptom Manage 2003; 26:855-859.
19. Sekine R, Obbens EA, Coyle N, Inturrisi CE. The successful use of parenteral methadone in a patient with a prolonged QTc interval. J Pain Symptom Manage 2007; 34:566-569.
20. Patel AM, Singh JP, Ruskin JN. Role of implantable cardioverter- defibrillators in patients with methadone-induced long QT syndrome. Am J Cardiol 2008; 101:209-211.