Torsade de Pointes due to Methadone Use in a Patient with HIV and Hepatitis C Coinfection

John, Jinu; Amley, Xixi; Bombino, Gabriel; Gitelis, Chaim; Topi, Bernard; Hollander, Gerald; Ghosh, Joydeep

doi:10.4061/2010/524764

Cited by 6 publications

(1 citation statement)

References 14 publications

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“…The high prevalence of illicit substance use in the PLWH population highlights the potential risk of methadoneassociated QTc prolongation. Methadone use was found to be an independent predictor of QTc prolongation in an injection drug use population, as well as the methadone dose used, presence of CYP3A4 inhibitors, potassium level and liver dysfunction in PLWH [65,66]. The mechanism of methadone QTc prolongation has demonstrated a dosedependent binding to hERG potassium ion channels [67].…”

Section: Methadonementioning

confidence: 99%

Abnormal QTc Syndrome in HIV-Infected Patients: A Systematic review of Prevalence and Risk Factors

2018

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Background The purpose of this review is to critically analyse data regarding the prevalence and risk factors for developing a prolonged QTc interval and subsequent sudden cardiac death (SCD) in persons living with HIV (PLWH). Methods A systematic literature search using PubMed and Google Scholar databases was performed using the following search terms: ‘HIV and prolonged QTc’ and ‘managing HIV-patients with prolonged QTc’. References within articles of interest were also evaluated. Results/Discussion PLWH are at an increased risk of having a prolonged QTc interval. Some risk factors for this include the virus itself, concomitant medications, comorbid conditions, addictions and electrolyte disturbances. PLWH who have an increased HIV RNA viral load or decreased CD4+ T-cell count are at further risk for progressing to sudden cardiac death (SCD). Many medications commonly prescribed in the PLWH population, such as antiretrovirals and antimicrobials used in opportunistic infection prophylaxis, have also been shown to promote QTc prolongation through inhibition of human ether-a-go-go potassium channels or through drug metabolism inhibition of other QTc prolonging drugs. Conclusions Due to the high number of risk factors associated with QTc prolongation, clinicians should incorporate baseline and routine ECG monitoring for PLWH to potentially lower the increased risk of SCD in PLWH.

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Section: Methadonementioning

confidence: 99%

Abnormal QTc Syndrome in HIV-Infected Patients: A Systematic review of Prevalence and Risk Factors

2018

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Electrocardiographic Findings in Mortalities Due to Pure Methadone Toxicity

2018

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We aimed to evaluate electrocardiographic (ECG) abnormalities in mortalities due to pure methadone toxicity in ICU patients since methadone-related mortality may be due to cardiac complications even in acute toxicities. In a retrospective single-center study, files of all patients who had died with confirmed diagnosis of pure methadone toxicity between 2011 and 2016 were evaluated. Autopsy was performed in all cases. A cardiologist measured all ECG quantitative and qualitative indices. Fifty-one deaths were recorded. Forty-two dead patients were males. Median [IQR] age of the patients was 44 [30, 60] years. Of them, 38 (69%) were methadone-dependent and were significantly older than methadone-naïve patients (p = 0.008 and p = 0.001, respectively). ECG abnormalities were detected in all cases. ST-T abnormalities were found in 33 (64.7%) patients. Except longer PR interval in dependent patients (p = 0.017) and specific ST elevation in naïve cases (p = 0.008), other ECG indices were similar in two groups. No correlation was found between ST-T abnormalities and coronary disease in autopsy. ECG abnormalities irrelevant to coronary artery diseases are common in methadone-related mortalities. Methadone toxicity may affect myocardium and play a role in death. Further prospective studies to evaluate other cardiac indices in methadone-poisoned patients are recommended.

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Methadone, synthetic opioids and torsades de pointes

Krantz

Haigney

2022

Torsades De Pointes

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Torsade de Pointes due to Methadone Use in a Patient with HIV and Hepatitis C Coinfection

Abstract: We present a case of Torsade de Pointes secondary to multiple factors including patient susceptibility and iatrogenic influences. Contributing causes are presented, and the approach to treatment is discussed.

Cited by 6 publications

References 14 publications

Abnormal QTc Syndrome in HIV-Infected Patients: A Systematic review of Prevalence and Risk Factors

Abnormal QTc Syndrome in HIV-Infected Patients: A Systematic review of Prevalence and Risk Factors

Electrocardiographic Findings in Mortalities Due to Pure Methadone Toxicity

Methadone, synthetic opioids and torsades de pointes

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