Torsade de Pointes Due to Methadone

A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone

“…9,[19][20][21] The association between methadone and occurrence of torsade de pointes has been documented in multiple case reports, now comprising at least 28 patients. 6,7,[11][12][13][14]22,23 Opioid agonists are among several classes of drugs that can prolong ventricular repolarization by blocking the action of cardiac human ether-a-go-go-related (HERG) potassium current (I HERG ). 24 However, among a range of opiates tested, methadone and LAAM had the most potent and rapid blockade of I HERG .…”

“…This phenomenon has been attributed to cardiac potassium ion channel blockade by the drug, resulting in prolongation of cardiac repolarization and a prolonged QT-interval on the electrocardiogram. [5][6][7][8][9][10][11][12][13][14] Given the current widespread use of methadone in the community, a community-based study would be useful to confirm this association, with the eventual goal of finding methods of enhancing safety of drug administration.…”

Magnetocardiographic identification of prolonged fetal corrected QT interval in women receiving treatment for opioid use disorder

“…Levo‐alpha‐Acetylmethadol, a mu‐agonist previously used for OUD, received a ‘black box’ warning from the Federal Drug Administration in the United States after reports of life‐threatening ventricular arrhythmias resulting from QT prolongation . Methadone, which is frequently used in the management of OUD during pregnancy, has also been implicated as a cause of Torsades du Pointes in adult patients, although the risk is lower when compared to that of Levo‐alpha‐Acetylmethadol . Buprenorphine has become increasingly popular in the treatment of opioid dependence disorder, in part because it appears to have less effect on the QTc when compared to methadone or Levo‐alpha‐Acetylmethadol .…”

“…20 Methadone, which is frequently used in the management of OUD during pregnancy, has also been implicated as a cause of Torsades du Pointes in adult patients, although the risk is lower when compared to that of Levo-alpha-Acetylmethadol. 21,22 Buprenorphine has become increasingly popular in the treatment of opioid dependence disorder, in part because it appears to have less effect on the QTc when compared to methadone or Levo-alpha-Acetylmethadol. 13 However, buprenorphine's effect is not negligible, as QT prolongation has still been documented with its use in adult patients.…”

Methadone‐associated Torsades de Pointes (polymorphic ventricular tachycardia) in opioid‐dependent patients

“…first reported methadone‐associated TdP in 2002 [7]. Since then, more reports on methadone‐associated TdP have been published [8–25]. As the numbers of opioid treatment programmes are increasing steadily world‐wide [5], it is inevitable that there will be a parallel rise in methadone‐associated TdP incidence.…”