Prognostic Factors in Acute Methadone Toxicity: A 5-Year Study

Abstract

Background. Delayed or recurrent profound respiratory depression, ventricular dysrhythmias, acute lung injury, and death are the major complications of MTD overdose. We aimed to clarify the prognostic factors in MTD toxicity. Materials and Methods. Retrospectively, medical files of all patients poisoned by MTD and older than 12 years of age who had presented to Loghman Hakim Poison Center between 2007 and 2012 were evaluated. The data was compared between survivors and nonsurvivors. Results. Twenty-eight out of 322 patients died (mortality rate = 8.7%). MTD-related death was higher in patients with acute on chronic toxicity who were on daily dose of MTD and had ingested higher doses (in comparison to those with acute toxicity due to first-time exposure; 13% versus 6%). Renal failure was the most common medical complication related to deaths due to MTD toxicity. Conclusions. Based on previous researches, the most common cause of MTD overdose-related deaths is respiratory impairment; however, in our study, acute renal failure with or without rhabdomyolysis was the main delayed cause of deaths in MTD-poisoned patients. Antidotal therapy, early recognition, and treatment of hemodynamic compromise and rhabdomyolysis can be life-saving in these patients.

Nephrotoxicity of methadone: a systematic review

“…Renal failure is an important cause of mortality and morbidity related to methadone toxicity (Corkery et al 2004; Aghabiklooei et al 2014), and rhabdomyolysis is responsible for most cases of AKI following methadone abuse. One of the debates on this topic is the unclear mechanism involved in methadone-induced rhabdomyolysis and AKI (Hojs and Sinkovič 1992).…”

“…In Iran and Australia, the main clinical replacement for opioid dependence is methadone syrup (Aghabiklooei et al 2014; Pilgrim et al 2013). …”

“…In two later studies, opiate toxicity was found to be the most common cause of rhabdomyolysis (Talaie et al 2007, 2008). In addition, rhabdomyolysis can be induced by methadone abuse (Criner et al 2002; Iranmanesh 2015; Gramenz et al 2010; Nanji and Douglas Filipenko 1983; Aghabiklooei et al 2014; Eizadi-Mood et al 2015). …”

“…More than 30,000 and 250,000 patients have been treated in methadone maintenance programs in Australia and America, respectively (Pilgrim et al 2013; Thanavaro and Thanavaro 2011). In Iran, there are currently more than 1500 methadone centers (Aghabiklooei et al 2014). …”

Drugs of abuse and addiction: A slippery slope toward liver injury

“…A case file study has suggested that methadone can increase QTc interval that makes methadone users vulnerable to malignant cardiac arrhythmias [116]. Methadone toxicity-induced death was associated with renal failure while respiratory failure was the leading cause of death [117]. When methadone is consumed along with other drugs it becomes hard to ascertain whether methadone overdose is the lead cause of death [118].…”