Ventricular arrhythmias in patients treated with methadone for opioid dependence

Hanon, Sam; Seewald, Randy; Yang, Felix; Schweitzer, Paul; Rosman, Jonathan

doi:10.1007/s10840-009-9465-9

Cited by 30 publications

(25 citation statements)

References 17 publications

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“…Differential cardiovascular effects are plausible due to the established risk of QT‐interval prolongation and serious arrhythmia associated with MET 66, 67. Two high ROB OBSs with poorly characterized methods of collecting and analyzing AEs had discordant findings.…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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AimsTo assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.MethodsWe searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies.ResultsThree RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.ConclusionsModerately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

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Section: Discussionmentioning

confidence: 99%

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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“…For the treatment of opioid addiction, buprenorphine has similar efficacy to moderate doses of methadone but is associated with less QTc interval prolongation, and is one potential alternative. 4,6,28,29,42,56,102 A QTc interval of 450 to 500 ms in adults is also associated with increased risk of torsades de pointes. 47,57,77 Data from general populations of U.S. adults indicate that less than 5% of men and women have QTc intervals of >450 ms. 83,111 Although the risk associated with a QTc interval of 450 to 500 ms is lower than in patients with QTc intervals of >500 ms, the panel recommends that clinicians consider alternatives to methadone because there may be some additional risk.…”

Section: Baseline Electrocardiogramsmentioning

confidence: 99%

“…In addition, clinicians may consider lowering the methadone dose with follow-up to document improvement or normalization of the QTc interval. 28,42,59 For patients treated for opioid addiction who develop a prolonged QTc interval on methadone, buprenorphine is a potential alternative. Buprenorphine has similar efficacy to moderate doses of methadone for treatment of opioid addiction, and observational studies report normalization of prolonged QTc intervals after switching patients from methadone to buprenorphine.…”

Section: Follow-up Electrocardiogramsmentioning

confidence: 99%

“…Buprenorphine has similar efficacy to moderate doses of methadone for treatment of opioid addiction, and observational studies report normalization of prolonged QTc intervals after switching patients from methadone to buprenorphine. 28,42,59 For chronic pain, a number of opioids are available as alternatives to methadone. A potential limitation to use of buprenorphine is that it is a m-opioid partial agonist and may exhibit analgesic ceiling dose effects at which further dose increases produce no additional effects.…”

Section: Follow-up Electrocardiogramsmentioning

confidence: 99%

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Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Chou

Cruciani

Fiellin

et al. 2014

The Journal of Pain

206

188

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Methadone is used for the treatment of opioid addiction and for treatment of chronic pain. The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths in recent years that has occurred in parallel with a dramatic rise in the use of methadone for chronic pain. The American Pain Society and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society, commissioned an interdisciplinary expert panel to develop a clinical practice guideline on safer prescribing of methadone for treatment of opioid addiction and chronic pain. As part of the guideline development process, the American Pain Society commissioned a systematic review of various aspects related Clinical practice guidelines are ''guides'' only and may not apply to all patients and all clinical situations. As part of a shared decision-making approach, it may be appropriate for the clinician to inform a patient that a particular recommendation may not be applicable, after considering all circumstances pertinent to that individual. This article is based on research conducted at the Oregon Evidence-based Practice Center (now the Pacific Northwest Evidence-based Practice Center) with funding from the American Pain Society (APS to safety of methadone. After a review of the available evidence, the expert panel concluded that measures can be taken to promote safer use of methadone. Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up. Although these guidelines are based on a systematic review, the panel identified numerous research gaps, most recommendations were based on low-quality evidence, and no recommendations were based on high-quality evidence.Perspective: This guideline, based on a systematic review of the evidence on methadone safety, provides recommendations developed by a multidisciplinary expert panel. Safe use of methadone requires clinical skills and knowledge in use of methadone to mitigate potential risks, including serious risks related to risk of overdose and cardiac arrhythmias. M ethadone is a synthetic opioid used for the treatment of opioid addiction and for treatment of chronic pain. 15,61 The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths.38 This increase appears largely related to the dramatic rise in the use of methadone for chronic pain, though a small proportion of deaths occur in patients treated for opioid addiction. 21,37,68,76,91,103 Methadone poisoning deaths in the United States increased steadily from about 800 in 1999 to a high of about 5,500 in 2007; th...

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“…In-vitro studies by Katchman et al found that LAAM and methadone are unique among opioids in their tendency to block a critical potassium conductance at concentrations approaching those achieved clinically [4]. Subsequent studies have confirmed that methadone can cause TdP and significantly prolongs the QT interval [5][6][7][8][9]. In a prospective investigation of 177 consecutive cases of sudden death, 72 (41%) were found to have detectable methadone on toxicology examination, while only 12 of 177 subjects (7%) had other opioids, suggesting that methadone is associated with a particular propensity for sudden death [10].…”

Section: The Qt Prolongation Phenomenon In Opioid Addiction Therapymentioning

confidence: 99%

Opioid addiction agonist therapy and the QT prolongation phenomenon: state of the science and evolving research questions

Wedam

Haigney

2013

Addiction

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Ventricular arrhythmias in patients treated with methadone for opioid dependence

Cited by 30 publications

References 17 publications

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Opioid addiction agonist therapy and the QT prolongation phenomenon: state of the science and evolving research questions

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