Methadone-associated Torsades de Pointes (polymorphic ventricular tachycardia) in opioid-dependent patients.
OBJECTIVE
We reviewed all the publications concerning methadone-associated Torsades de Pointes (TdP) (polymorphic ventricular tachycardia) in opioid-dependent patients in order to characterize the clinical circumstances leading to this serious complication.


METHODS
Our literature search yielded 14 reports on 40 patients with methadone-associated TdP. We gathered and recorded the risk factors for TdP mentioned in those reports, among other clinical aspects.


RESULTS
The most prevalent risk factors for TdP were high-dose methadone (n = 39, 97.5%) and concomitant use of agents that increase serum methadone levels or trigger TdP (n = 22, 55%). HIV infection (n = 16), hypokalaemia (n = 14), female sex (n = 13), liver cirrhosis or renal failure (n = 11) and heart disease (n = 9) were also described. All the patients had at least one and 34 (85%) had two or more risk factors for TdP during methadone treatment.


CONCLUSIONS
We wish to raise the level of awareness of risk factors for TdP among physicians in heroin-treatment clinics who frequently prescribe methadone.
Justo
Dan
D
Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, Tel Aviv 64239, Israel. justo1@bezeqint.net
Gal-Oz
Amir
A
Paran
Yael
Y
Goldin
Yelena
Y
Zeltser
David
D
D000328:Adult; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D008691:Methadone / Q000009:adverse effects*; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000139:chemically induced; D012307:Risk Factors; D016171:Torsades de Pointes / Q000139:chemically induced*
D009294:Narcotics; D008691:Methadone