The Impact of Methadone Induction on Cardiac Conduction in Opiate Users
Authors: Bridgett A. Martell, Julia H. Arnsten, Beevash Ray, Marc N. Gourevitch
Journal: Annals of Internal Medicine (2003)

Letters15 July 2003The Impact of Methadone Induction on Cardiac Conduction in Opiate UsersBridget A. Martell, MD, Julia H. Arnsten, MD, MPH, Beevash Ray, BS, and Marc N. Gourevitch, MD, MPHBridget A. Martell, MDAlbert Einstein College of Medicine; Bronx, NY 10467 (Martell, Arnsten)Tufts University School of Medicine; Boston, MA 02111 (Ray)Albert Einstein College of Medicine; Bronx, NY 10467 (Gourevitch)Search for more papers by this author, Julia H. Arnsten, MD, MPHAlbert Einstein College of Medicine; Bronx, NY 10467 (Martell, Arnsten)Tufts University School of Medicine; Boston, MA 02111 (Ray)Albert Einstein College of Medicine; Bronx, NY 10467 (Gourevitch)Search for more papers by this author, Beevash Ray, BSAlbert Einstein College of Medicine; Bronx, NY 10467 (Martell, Arnsten)Tufts University School of Medicine; Boston, MA 02111 (Ray)Albert Einstein College of Medicine; Bronx, NY 10467 (Gourevitch)Search for more papers by this author, and Marc N. Gourevitch, MD, MPHAlbert Einstein College of Medicine; Bronx, NY 10467 (Martell, Arnsten)Tufts University School of Medicine; Boston, MA 02111 (Ray)Albert Einstein College of Medicine; Bronx, NY 10467 (Gourevitch)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-2-200307150-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: Opiate agonist therapy, specifically levacetylmethadol and high doses of methadone (>300 mg/d), has been associated with QT interval prolongation and torsade de pointes in two recent reports (1, 2). However, no prospective studies have examined the impact of methadone induction on the QT interval. We therefore sought to determine whether methadone is associated with acquired prolonged QT syndrome. We performed serial electrocardiography (ECG) before and during methadone induction and stabilization in a cohort of opiate users who were newly enrolled in a university-affiliated methadone maintenance treatment program in the Bronx, New York.Methods: Between December 2001 ...References1. Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Torsade de pointes associated with very-high-dose methadone. Ann Intern Med. 2002;137:501-4. [PMID: 12230351] LinkGoogle Scholar2. Huber A, Ling W, Fradis J, Charuvastra VC. Comparison of the effects of methadone and LAAM on the EKG [Abstract]. Drug Alcohol Depend. 2001;63:S70. Google Scholar3. Bazett HC. An analysis of the time-relation of electrocardiograms. Heart. 1920;7:353-70. Google Scholar4. Haverkamp W, Breithardt G, Camm AJ, Janse MJ, Rosen MR, Antzelevitch C, . The potential for QT prolongation and pro-arrhythmia by non-anti-arrhythmic drugs: clinical and regulatory implications. Report on a Policy Conference of the European Society of Cardiology. Cardiovasc Res. 2000;47:219-33. [PMID: 10947683] CrossrefMedlineGoogle Scholar5. Committee for Proprietary Medicinal Products (CPMP). Points to consider: the assessment of the potential for QT interval prolongation by non-cardiovascular medicinal products. The European Agency for the Evaluation of Medicinal Products. 17 December 1997. CPMP/986/96. Accessed at www.health.gov.au/tga/docs/pdf/euguide/swp/098696en.pdf on 4 June 2003. Google Scholar Author, Article, and Disclosure InformationAffiliations: Albert Einstein College of Medicine; Bronx, NY 10467 (Martell, Arnsten)Tufts University School of Medicine; Boston, MA 02111 (Ray)Albert Einstein College of Medicine; Bronx, NY 10467 (Gourevitch)Grant Support: Dr. Arnsten was supported in part by a Robert Wood Johnson Generalist Physician Faculty Award. Mr. Ray was supported in part by the New York State Department of Health. The Division of Substance Abuse at Albert Einstein College of Medicine is funded in part by contract C-002464 from the New York State Office of Alcoholism and Substance Abuse Services. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTorsade de Pointes Associated with Very-High-Dose Methadone Mori J. Krantz , Laurent Lewkowiez , Helen Hays , Mary Ann Woodroffe , Alastair D. Robertson , and Philip S. Mehler Torsades de Pointes Due to Methadone David De Bels , Michel Staroukine , and Jacques Devriendt Metrics Cited ByLong QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should KnowMethadone for Pain Management: A Pharmacotherapeutic ReviewOpioid Withdrawal Precipitated by Long-Acting AntagonistsCorrected QT Interval Prolongation in Hospitalized Pediatric Patients Receiving MethadoneEffects of Methadone on Corrected Q-T Interval Prolongation in Critically Ill ChildrenPharmacogenetics of Methadone ResponseMethadone Therapy in Underserved Urban Community: QTc Prolongation and Life-Threatening Ventricular ArrhythmiasPharmacological treatments for drug misuse and dependencePolypharmacy and Drug InteractionPharmacogenomics of methadone maintenance treatmentPain and Addictive DisordersChanges of QTc interval after opioid switching to oral methadoneMethadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the 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improving pharmacotherapy for dependence on illegal opioids and lessons learned for pharmacologyQTc Prolongation and Torsades de Pointes Associated with Methadone TherapyCorrected-QT intervals as related to methadone dose and serum level in methadone maintenance treatment (MMT) patients-a cross-sectional studyMethadone Death, Dosage and Torsade de Pointes: Risk-Benefit Policy ImplicationsMethadone and the QT IntervalMethadone for treatment of cancer painOpioid Switching from Morphine to Methadone Causes a Minor But Not Clinically Significant Increase in QTc Time: A Prospective 9-Month Follow-Up StudyQT prolongation and torsades de pointes among methadone users: reports to the FDA spontaneous reporting systemTorsades de Pointes During Methadone TreatmentMethadone doses of 100 mg or greater are more effective than lower doses at suppressing heroin self-administration in opioid-dependent volunteersTorsade de pointes durante el tratamiento con metadonaEfficacy of dose and contingency management procedures in LAAM-maintained cocaine-dependent patientsSubstance misuseMethadone-relatedtorsades de pointes in a sickle cell patient treated for chronic painImpact of methadone treatment on cardiac repolarization and conduction in opioid usersMeasurement of QTc in Patients Receiving Chronic Methadone TherapyBuprenorfina en dependencia a opiáceos: reflexiones sobre la seguridadCocaine-Related Torsade de Pointes in a Methadone Maintenance PatientDrugs of abuseMale/Female Differences in Pharmacology: Safety Issues with QT-Prolonging DrugsOral methadone for cancer pain: no indication of Q-T interval prolongation or torsades de pointesCan methadone prolong the QT interval?Methadone and QT prolongation: a dose-dependent effect?Combating opiate dependence: a comparison among the available pharmacological options 15 July 2003Volume 139, Issue 2Page: 154-155KeywordsArrhythmiaHeart rateHeroin useHispanic peopleInstitutional review boardsOpiatesOpioidsPatientsProspective studiesStatistical data ePublished: 15 July 2003 Issue Published: 15 July 2003 CopyrightCopyright © 2003 by American College of Physicians. 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