First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction

Lemesle, Frédéric; Lemesle, F.; Nicola, Walid; Jonville-Béra, Annie Pierre

doi:10.1016/j.ajem.2009.07.007

Cited by 24 publications

(11 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most dangerous side effect of methadone is torsade de pointes (TdP) [18-22], which may threaten a patient's life. MDIs can either increase [23] or decrease [24] serum methadone levels, leading to treatment failure or even death [19,25]. Therefore, proper methadone dose adjustment and therapeutic drug monitoring should be handled with caution when MMTP patients also have received other medicines that could yield TdP or interfere with the activities of cytochrome P 450 (CYP450) enzymes, such as 3A4 [26], 2B6 [26,27], 2C19 [27] or 2D6 [28].…”

Section: Introductionmentioning

confidence: 99%

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

Lee

et al. 2012

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

BackgroundAlthough methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community.MethodsThe study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged ≥ 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) ≥ 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined.Results128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP.ConclusionsThe results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

Lee

et al. 2012

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

show abstract

“…The sympathetic overstimulation can be caused by pheochromocytoma, exogenous sympathomimitics, or the withdrawal of sympathetic antagonists, such as opioids [7][8][9][10] . Fentanyl is potent, synthetic opioid analgesic, approximately 50-100 J Korean Geriatr Soc 19(2) June 2015 101 times more potent than morphine on a dose-by-dose basis.…”

Section: Discussionmentioning

confidence: 99%

Stress Cardiomyopathy due to Misuse of TransdermalFentanyl Patches in an Elderly Patient

Song

Rhew

Lim

et al. 2015

J Korean Geriatr Soc

View full text Add to dashboard Cite

Stress cardiomyopathy is characterized by transient systolic dysfunction of the apical and/or mid segment of the left ventricle. The main pathophysiology of stress cardiomyopathy is the excessive release of catecholamine. Opioid withdrawal can initiate a surge of catecholamine and an attack of stress cardiomyopathy. In this case, we report a case of stress cardiomyopathy due to iatrogenic withdrawal from transdermal fentanyl.

show abstract

“…15,16 Although the association between methadone withdrawal and TTC has already been reported, in two previous cases the syndrome occurred soon after administration of an opioid antagonist while in our patient heart failure developed late after methadone discontinuation as a consequence of the drug pharmacokinetic. 13,14 Furthermore, to our knowledge, this is the first report to highlight the efficacy of clonidine administration in addition to standard therapy in counteracting the causative mechanism of TTC. Clonidine is a central sympatholytic drug which decreases presynaptic alpha-2 receptors in the locus coeruleus and is an effective treatment for opioid withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…2 The sympathetic overstimulation can also be caused by pheochromocytoma, exogenous sympathomimetics, or withdrawal of sympathetic antagonists, such as opioids. [8][9][10][11][12][13][14] Methadone is a synthetic opioid prescribed as an analgesic and anti-addictive drug. By binding to the opioids receptor, it reduces the euphoric effect of illicit drugs such as heroin and, at the same time, mitigates withdrawal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Heart failure due to ‘stress cardiomyopathy’: a severe manifestation of the opioid withdrawal syndrome

Spadotto

Zorzi

ElMaghawry

et al. 2013

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction due to akinesia of the LV mid-apical segments ('apical ballooning') in the absence of critical coronary stenoses which can be complicated in the acute phase by heart failure, mitral regurgitation, life-threatening ventricular arrhythmias, or apical LV thrombosis. The syndrome is typically precipitated by intense emotional or physical stress; however, other causes of sympathetic overstimulation including administration of exogenous sympathomimetics or withdrawal of sympathetic antagonists can trigger TTC. We report the case of a patient who unexpectedly developed an 'apical ballooning' with severe reduction in the LV systolic function and heart failure after the withdrawal of methadone. The case supports the concept that increased sympathetic activity secondary to opioids withdrawal can trigger a stress-induced severe LV dysfunction. Physicians should be aware that the abrupt discontinuation of a long-term therapy with opioids may lead to serious cardiac complications. The administration of clonidine may be considered to prevent early clinical manifestations of addictive withdrawal, including TTC.

show abstract

First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction

Cited by 24 publications

References 4 publications

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

Stress Cardiomyopathy due to Misuse of TransdermalFentanyl Patches in an Elderly Patient

Heart failure due to ‘stress cardiomyopathy’: a severe manifestation of the opioid withdrawal syndrome

Contact Info

Product

Resources

About