Successful transition to buprenorphine in a patient with methadone-induced torsades de pointes

Esses, Jason; Rosman, Jonathan; Thanh, Lien; Schweitzer, Paul; Hanon, Sam

doi:10.1007/s10840-008-9280-8

Cited by 24 publications

(7 citation statements)

References 7 publications

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“…Another study indicated that buprenorphine is a safe drug in common daily doses (11 ± 5 mg) [37]. Encouraging the idea of choosing buprenorphine over methadone, a case report showed that buprenorphone was able to settle QT prolongation and ventricular arrhythmia secondary to methadone [38]. Thus, based on the studies mentioned above, buprenorphine at conventional doses, by itself, does not appear to produce clinically significant QT interval prolongation and arrhythmia, and is a safe drug in this respect.…”

Section: Prolongation Of Qt Interval and Ventricular Arrhythmiamentioning

confidence: 99%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

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Objective: One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability. Methods: By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions. Results: Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation. Conclusion: The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.

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Section: Prolongation Of Qt Interval and Ventricular Arrhythmiamentioning

confidence: 99%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

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“…The curves represent the prediction based on a f u,p of 0.22 (black line), 0.15 (red line), 0.055 (blue line) and 0.034 (green line). Symbols represent the data obtained from case reports, case series of individuals (orange triangles) (Esses et al 2008 ; Fredheim et al 2006 ; Krantz et al 2002 ) and other studies as follows: Bart et al ( 2017 ) (purple circle); Carlquist et al ( 2015 ) (orange square); Chang et al ( 2012 ) (green circle) Chowdhury et al ( 2015 ); (dark blue cross); Cruciani et al ( 2005 ) (green cross) Eap et al ( 2007 ); (green star); Ehret et al ( 2006 ) (dark blue triangle) Fareed et al ( 2013 ); (dark blue circle) Heesch et al ( 2015 ); (dark blue star) Krantz et al ( 2005 ); (orange circles) Maremmani et al ( 2005 ); (green square); Martell et al ( 2005 ) (green triangle) Peles et al ( 2007 ); (orange star); Reddy et al ( 2010 ) (orange circles) Roy et al ( 2012 ); (dark blue square). The in vivo data are summarized in Table S1 and S2 (color figure online) …”

Section: Resultsmentioning

confidence: 99%

Section: Evaluation Of the Pbk Modeling-based Reverse Dosimetry Appromentioning

confidence: 99%

Integrating in vitro data and physiologically based kinetic modeling-facilitated reverse dosimetry to predict human cardiotoxicity of methadone

et al. 2020

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Development of novel testing strategies to detect adverse human health effects is of interest to replace in vivo-based drug and chemical safety testing. The aim of the present study was to investigate whether physiologically based kinetic (PBK) modeling-facilitated conversion of in vitro toxicity data is an adequate approach to predict in vivo cardiotoxicity in humans. To enable evaluation of predictions made, methadone was selected as the model compound, being a compound for which data on both kinetics and cardiotoxicity in humans are available. A PBK model for methadone in humans was developed and evaluated against available kinetic data presenting an adequate match. Use of the developed PBK model to convert concentration–response curves for the effect of methadone on human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) in the so-called multi electrode array (MEA) assay resulted in predictions for in vivo dose–response curves for methadone-induced cardiotoxicity that matched the available in vivo data. The results also revealed differences in protein plasma binding of methadone to be a potential factor underlying variation between individuals with respect to sensitivity towards the cardiotoxic effects of methadone. The present study provides a proof-of-principle of using PBK modeling-based reverse dosimetry of in vitro data for the prediction of cardiotoxicity in humans, providing a novel testing strategy in cardiac safety studies.

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“…Additionally, other studies depict differences regarding quality of life, which seem to improve more positively amongst patients treated with B/N than amongst MT patients 76 . B/N use seems also better than MT therapy as far as security is concerned, for it features lower overdose 36,50,[77][78][79] and QT interval prolongation [80][81][82][83][84] risks. As regards the interaction profile, B/N is globally better than MT 85 and it can be prescribed without causing withdrawal syndrome amongst HIV infected patients when combined with non-nucleoside reverse transcriptase inhibitors (NNRTI), such as efavirenz or nevirapine 86 .…”

Section: Differences Between Mt and B/n Usementioning

confidence: 99%

¿Es necesario disponer de tratamientos con buprenorfina/naloxona para los presos dependientes de opiáceos?

Marco¹,

López-Burgos²,

García‐Marcos³

et al. 2013

Rev. esp. sanid. penit.

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Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective way to prevent relapse in opioid-dependent patients. These programs reduce morbidity and risk behaviours for HIV transmission and other infections, improve quality of life and retention in treatment, and have a positive impact on antisocial behaviour. They are therefore very useful for prisoners with a history of opiate use. OATs based on buprenorphine/naloxone (B/N), along with others using methadone, are currently available in Spain. Diversified treatment offers an alternative treatment for opioid dependence that is more personalized and tailored to the patient's characteristics. As regards effectiveness, both drugs are very similar, but B/N shows a better safety profile and fewer drug-drug interactions and can be dispensed in pharmacies once the patient is released, which can assist with the patient' social reintegration. B/N treatment is more expensive than methadone. It is advisable to have different modes of OAT. These should be prescribed according to the characteristics and needs of each case, without incarceration impeding the right to drug treatment, which should be similar to that performed outside prison.

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Successful transition to buprenorphine in a patient with methadone-induced torsades de pointes

Cited by 24 publications

References 7 publications

Opioids and Cardiac Arrhythmia: A Literature Review

Opioids and Cardiac Arrhythmia: A Literature Review

Integrating in vitro data and physiologically based kinetic modeling-facilitated reverse dosimetry to predict human cardiotoxicity of methadone

¿Es necesario disponer de tratamientos con buprenorfina/naloxona para los presos dependientes de opiáceos?

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