Drug-Induced Long QT Syndrome in Injection Drug Users Receiving Methadone

Ehret, Georg; Voide, Cathy; Gex‐Fabry, Marianne; Chabert, Jocelyne; Shah, Dipen; Broers, Barbara; Piguet, Valérie; Musset, Thierry; Gaspoz, Jean‐Michel; Perrier, Arnaud; Dayer, P.; Desmeules, Jules Alexandre

doi:10.1001/archinte.166.12.1280

Cited by 212 publications

(164 citation statements)

References 32 publications

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“…[17]. Pharmaco-economic studies support its use, but several recent studies show the occurrence of cardiac side eff ects, such as QT prolongation, indicating the need for medical supervision of patients in methadone maintenance treatment [18]. Its negative characteristics, high addictive potential, are oft en the cause of abuse, addiction, and overdose.…”

Section: Discussionmentioning

confidence: 99%

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Crnic¹,

Todorovic²

2017

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Opiate dependence is a serious, chronic and recurrent psychiatric disorder, whose prevalence reach epidemic proportions. This also contributes to a signifi cant increase in mortality, associated with overdose with opiates, as well as the rise in other health and social problems of the society. The methods and availability of treatment do not correspond to increased treatment needs, and treatment success is limited by the characteristics of the disorder, or numerous risk factors, which contribute to a high percentage of recidivism. Good clinical practice guidelines have defi ned treatment recommendations that include high and low-demanding programs. The personalized and integrative approaches are emphasized. Case report: The patient aged 41 years, intravenous-use opiate addict from his adolescences, with numerous psychological, health and social complications of addiction, is a participant in institutional treatment, following a court order as a measure of obligatory treatment, due to criminal off enses related to addiction. The history of the disease refers to numerous unsuccessful attempts to heal and short-term abstinence in the past, mainly in penal institutions. The patient meets all the criteria defi ned by the guidelines for inclusion in the buprenorphine maintenance program started in the year 2013. During the four-year treatment, the doses of the drug were adapted as needed; two heroin relapses and many in-risk situations for relapse were registered. The treatment continuated with close monitoring of the patient's condition and, with appropriate psychosocial interventions, contribute to keeping the patient in treatment and preventing the development of new complications of addiction, as well an improving the quality of his life. Discussion: Pharmacological treatment of opioid dependence relies on agents belonging to groups of antagonists, agonists and partial agonists of opiate receptors. The earlier programs with abstinence as a treatment goal have signifi cantly allocated the place to "harm reduction" programs, where the therapeutic goals are less demanding and defi ned as the harm-reduction of opiate dependence on the individual and the society. Treatment guidelines defi ne the principles and types of treatment regimens with agonists and partial agonists of opiate receptors and most commonly used are methadone and buprenorphine. The high risk of relapses despite treatment is defi ned and a comprehensive approaches and inclusion of Cognitive Behavior Therapy /CBT/, family and social therapy are needed.

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Section: Discussionmentioning

confidence: 99%

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Crnic¹,

Todorovic²

2017

Hosp Pharm Int Multi J

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“…Mortality may reach 17% and previous electrocardiographic monitoring is recommended before the use of such agents. In heroin-addicts being treated with methadone, the occurrence of tachycardia related to prolonged QT interval (above 500ms) was 16% and of Tdp rhythm of 3.6% 19 . Some authors have observed that interval above 30ms should be considered significant and above 60ms a risk factor for Tdp Education and guidance to patient and relatives are essential to treat constipation.…”

Section: Cardiovascular Effectmentioning

confidence: 97%

Total temporomandibular joint alloplastic reconstruction

Ferreira¹,

Cunali²,

Bonotto³

et al. 2014

Revista Dor

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“…Ils avaient été recrutés alors qu'ils étaient hospitalisés dans un centre de soins tertiaires (Ehret, 2006). Dans ce groupe, 16,2 % des 167 patients sous méthadone avaient un QTc > 500, comparativement à aucun dans le groupe témoin de 80 patients.…”

Section: Allongement Du Qtunclassified

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

Lauzon

2012

dss

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Le traitement de substitution, principalement avec la méthadone ou la buprénorphine, représente le traitement le plus efficace de la dépendance des opioïdes. Ces médicaments doivent, la plupart du temps, être pris pendant des périodes prolongées, soit plusieurs années ou toute la vie pour certains. Ces médicaments peuvent avoir des effets indésirables, ayant un impact sur la qualité de vie des patients, et nécessitent une attention de la part des professionnels de la santé impliqués dans le traitement. Seront révisés les effets indésirables suivants : hypogonadisme masculin, allongement du QT, sevrage néonatal, anomalies des fonctions respiratoires, hyperalgésie, risque d’intoxication, abus de la médication, interactions médicamenteuses. À ces effets pharmacologiques viennent s’ajouter des contraintes réglementaires, qui, si elles peuvent être pertinentes en début de traitement, s’avèrent lourdes et inadaptées pour les patients stables depuis plusieurs années. De l’écoute et une bonne gestion de ces effets indésirables sont indispensables pour améliorer l’acceptabilité du traitement et son attrait pour les usagers.

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Drug-Induced Long QT Syndrome in Injection Drug Users Receiving Methadone

Cited by 212 publications

References 32 publications

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Total temporomandibular joint alloplastic reconstruction

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

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