Methadone maintenance, QTc and torsade de pointes: Who needs an electrocardiogram and what is the prevalence of QTc prolongation?

Drug and Alcohol Review

Volumn 30, Issue 4, 2011, Pages 388-396

  Mayet, Soraya ^a,b   Gossop, Michael ^b   Lintzeris, Nicholas ^c   Markides, Vias ^d   Strang, John ^b  

^a The Royal College of Psychiatrists   (United Kingdom)

^b KING'S COLLEGE LONDON   (United Kingdom)

^c UNIVERSITY OF SYDNEY   (Australia)

^d ROYAL BROMPTON AND HAREFIELD NHS FOUNDATION TRUST   (United Kingdom)

Author keywords

Cardiac risk; Heroin dependence; Methadone maintenance; QT prolongation; Torsade de pointes

Indexed keywords

METHADONE; NARCOTIC ANALGESIC AGENT;

ADULT; ARTICLE; CHEMICALLY INDUCED DISORDER; CROSS-SECTIONAL STUDY; ELECTROCARDIOGRAPHY; FEMALE; HUMAN; LONG QT SYNDROME; MALE; MIDDLE AGED; OPIATE SUBSTITUTION TREATMENT; OUTPATIENT; PRACTICE GUIDELINE; QUESTIONNAIRE; RISK FACTOR; TORSADE DES POINTES; UNITED KINGDOM;

ADULT; ANALGESICS, OPIOID; CROSS-SECTIONAL STUDIES; ELECTROCARDIOGRAPHY; FEMALE; HUMANS; LONDON; LONG QT SYNDROME; MALE; METHADONE; MIDDLE AGED; OPIATE SUBSTITUTION TREATMENT; OUTPATIENTS; PRACTICE GUIDELINES AS TOPIC; QUESTIONNAIRES; RISK FACTORS; TORSADES DE POINTES;

EID: 79959999873     PISSN: 09595236     EISSN: 14653362     Source Type: Journal    
DOI: 10.1111/j.1465-3362.2010.00237.x     Document Type: Article

References (42)

1. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2003;(2):CD002209.
2. 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;137:501-4.
3. Krantz MJ, Kutinsky IB, Robertson AD, Mehler PS. Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes. Pharmacotherapy 2003;23:802-5.
4. Lipski J, Stimmel B, Donoso E. The effect of heroin and multiple drug abuse on the electrocardiogram. Am Heart J 1973;86:663-8.
5. EMEA. EMEA Public Statement on the recommendation to suspend the marketing authorisation for ORLAAM (Levacetylmethadol) in the European Union. London: European Medicines Agency, 2001. Available from URL.
6. Huber A, Ling W, Fradis J, Charuvastra VC. Comparison of the effects of methadone and LAAM on the Electrocardiogram. Drug Alcohol Depend 2001;63(Suppl.):272.
7. MHRA and Commission on Human Medicines. Risk of QT interval prolongation with methadone. 2006 May. Report No.: 31.
8. US Food and Drug Administration. Methadone use for pain control may result in death and life-threatening changes in breathing and heart beat. Internet. 27-11-2006. Ref Type: Generic.
9. Moss AJ. Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol 1993;72:23B-5B.
10. EMEA. ICH Topic E 14: the clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs. London: European Medicines Agency, 2005. Available from URL.
11. Botstein P. Is QT interval prolongation harmful? A regulatory perspective. Am J Cardiol 1993;72:50B-2B.
12. Rubart M, Zipes DP. Mechanisms of sudden cardiac death. J Clin Invest 2005;115:2305-15.
13. Gil M, Sala M, Anguera I, etal. QT prolongation and Torsades de Pointes in patients infected with human immunodeficiency virus and treated with methadone. [See comment]. Am J Cardiol 2003;92:995-7.
14. Pearson EC, Woosley RL. QT prolongation and torsades de pointes among methadone users: reports to the FDA spontaneous reporting system. Pharmacoepidemiol Drug Saf 2005;14:747-53.
15. Piguet V, Desmeules J, Ehret G, Stoller R, Dayer P. QT interval prolongation in patients on methadone with concomitant drugs. J Clin Psychopharmacol 2004;24:446-8.
16. Sticherling C, Schaer BA, Ammann P, Maeder M, Osswald S. Methadone-induced Torsade de pointes tachycardias. Swiss Med Wkly 2005;135:282-5.
17. Cruciani RA, Sekine R, Homel P, etal. Measurement of QTc in patients receiving chronic methadone therapy. J Pain Symptom Manage 2005;29:385-91.
18. Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93:1051-5.
19. Fonseca F, Marti-Almor J, Pastor A, etal. Prevalence of long QTc interval in methadone maintenance patients. Drug Alcohol Depend 2009;99:327-32.
20. Peles E, Bodner G, Kreek MJ, Rados V, Adelson M. Corrected-QT intervals as related to methadone dose and serum level in methadone maintenance treatment (MMT) patients: a cross-sectional study. Addiction 2007;102:289-300.
21. Fredheim OM, Borchgrevink PC, Hegrenaes L, Kaasa S, Dale O, Klepstad P. Opioid switching from morphine to methadone causes a minor but not clinically significant increase in QTc time: a prospective 9-month follow-up study. J Pain Symptom Manage 2006;32:180-5.
22. Martell BA, Arnsten JH, Krantz MJ, Gourevitch MN. Impact of methadone treatment on cardiac repolarization and conduction in opioid users. Am J Cardiol 2005;95:915-18.
23. Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MC. QT-interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med 2007;167:2469-75.
24. Katchman AN, McGroary KA, Kilborn MJ, etal. Influence of opioid agonists on cardiac human ether-a-go-go-related gene K(+) currents. J Pharmacol Exp Ther 2002;303:688-94.
25. Krook AL, Waal H, Hansteen V. Routine ECG in methadone-assisted rehabilitation is wrong prioritization. [Norwegian]. Tidsskr Nor Laegeforen 2004;124:2940-1.
26. MEDSAFE. Cardiac Vigilance Recommended for Methadone: New Zealand Medicines and Medical Devices Safety Authority. Prescriber Update 2, 23-25. 2005. Ref Type: Generic.
27. DH. Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health, 2007.
28. Marsden J, Gossop M, Stewart D, etal. The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome 332. Addiction 1998;93:1857-67.
29. Darpo B, Agin M, Kazierad DJ, etal. Man versus machine: is there an optimal method for QT measurements in thorough QT studies? J Clin Pharmacol 2006;46:598-612.
30. Mayet S. QT Prolongation and Opioid Maintenance Treatment Doctor of Medcine Thesis. 2009. Ref Type: Unpublished Work.
31. Fareed A, Vayalapalli S, Byrd-Sellers J, etal. Onsite QTc interval screening for patients in methadone maintenance treatment. J Addict Dis 2010;29:15-22.
32. Kornick CA, Kilborn MJ, Santiago-Palma J, etal. QTc interval prolongation associated with intravenous methadone. Pain 2003;105:499-506.
33. ABPI. Medicines compendium 2008: summary of product characteristics. 2008. Ref Type: Generic.
34. Anchersen K, Clausen T, Gossop M, Hansteen V, Waal H. Prevalence and clinical relevance of corrected QT interval prolongation during methadone and buprenorphine treatment: a mortality assessment study. Addiction 2009;104:993-9.
35. Athanasos P, Farquharson AL, Compton P, Psaltis P, Hay J. Electrocardiogram characteristics of methadone and buprenorphine maintained subjects. J Addict Dis 2008;27:31-5.
36. Faggiano F, Vigna-Taglianti F, Versino E, Lemma P. Methadone maintenance at different dosages for opioid dependence. Cochrane Database Syst Rev 2003;(3):CD002208.
37. Ehret GB, Voide C, Gex-Fabry M, etal. Drug-induced long QT syndrome in injection drug users receiving methadone: high frequency in hospitalized patients and risk factors. [See comment]. Arch Intern Med 2006;166:1280-7.
38. Haigney MC, Alam S, Tebo S, etal. Intravenous cocaine and QT variability. J Cardiovasc Electrophysiol 2006;17:610-16.
39. Krantz MJ, Rowan SB, Mehler PS. Cocaine-related torsade de pointes in a methadone maintenance patient. J Addict Dis 2005;24:53-60.
40. Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med 2009;150:387-95.
41. Cohen SP, Mao J. Concerns about consensus guidelines for QTc interval screening in methadone treatment417. Ann Intern Med 2009;151:216-17.
42. Strang J, Manning V, Mayet S, Ridge G, Best D, Sheridan J. Does prescribing for opiate addiction change after national guidelines? Methadone and buprenorphine prescribing to opiate addicts by general practitioners and hospital doctors in England, 1995-2005. Addiction 2007;102:761-70.