title: Methadone-associated Torsades de Pointes (polymorphic ventricular tachycardia) in opioid-dependent patients.
abstract: 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.
authors.affiliation: 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
authors.forename: Dan
authors.initials: D
authors.lastname: Justo
authors.forename: Amir
authors.initials: A
authors.lastname: Gal-Oz
authors.forename: Yael
authors.initials: Y
authors.lastname: Paran
authors.forename: Yelena
authors.initials: Y
authors.lastname: Goldin
authors.forename: David
authors.initials: D
authors.lastname: Zeltser
mesh_terms: 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*
chemical_list: D009294:Narcotics; D008691:Methadone