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JPP · Lens · Comprehensive Review on Methadone-Induced QT Prolongation and Torsades

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Review · Volume 9, Issue 2 · pp. 66–75

Comprehensive Review on Methadone-Induced QT Prolongation and Torsades

Jennifer M Treece1, Mohammad Madani2, George Khoury3, Ola Khraisha4, James E Martin5, Steven J Baumrucker6, Christopher A Neglia7, Timir K Paul7

  1. 1Departments of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
  2. 2Department of Interventional Cardiology, Kings Daughter Medical Center, Portsmouth, Ohio and Ashland, Kentucky, USA.
  3. 3Division of Cardiology, Heart Clinic of Hammond, Hammond, Louisiana, USA.
  4. 4Department of Family Medicine, Lincoln-Debusk College of Osteopathic Medicine, TN, USA.
  5. 5Department of Hospice and Palliative Medicine, Wellmont Health System, TN, USA.
  6. 6Holston Medical Group, Kingsport, TN, USA.
  7. 7Department of Cardiology, East Tennessee State University, Johnson City, TN, USA.

Abstract

An alternative analgesic to morphine is methadone, which is used to control chronic pain and is used in opioid rehabilitation treatment programs due to methadone having a long half-life and being relatively inexpensive as compared to extended-release forms of morphine. Despite its benefits, methadone accumulates in adipose tissue due to being lipophilic, binds strongly to plasma proteins, and is metabolized in the liver by the cytochrome P450 system causing methadone levels to be variable and subject to influence according to the individual body compositions and concurrent use of cytochrome P450 inhibitors. In addition to methadone being able to cause both respiratory and central nervous system depression, methadone can also prolong the QT interval and cause potentially life-threatening arrhythmias including torsades de pointes. The susceptibility of unintentional overdosing of methadone due to its varied pharmacologic properties and potentially fatal induction of arrhythmias may cause the risks of methadone use to outweigh its benefits and therefore must be closely monitored.

Keywords: Analgesic; dysrhythmia; methadone; opioid; torsade de pointes

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