Ventricular arrhythmias in patients treated with methadone for opioid dependence.
OBJECTIVE
Over the last decade, there has been a significant rise in reported cases of methadone induced QT prolongation (QTP) and Torsades de Pointes (TdP) in patients treated for opioid dependence. Optimal management of these patients is challenging.


METHODS
We report a case series of 12 consecutive patients admitted to our institution with methadone-induced QTP and ventricular arrhythmias.


RESULTS
All patients survived the presenting arrhythmia. Successful transition to buprenorphine was accomplished in three patients. QT interval normalized and none of these patients had recurrent arrhythmias. Methadone dose was reduced in five patients with improvement of QT interval and resolution of arrhythmia. Four patients, including two with ICDs, refused or did not tolerate a reduction in their methadone dose.


CONCLUSIONS
Ventricular arrhythmias in patients on methadone are an uncommon but important problem. Buprenorphine, a partial micro-opiate-receptor agonist and a kappa-opiate-receptor antagonist does not cause QTP or TdP. Buprenorphine is a useful and effective alternative to methadone in a select group of patients, including those with documented ventricular arrhythmias on methadone. Pacemakers or defibrillators should be reserved for patients who have failed buprenorphine or a reduced methadone dose.
Hanon
Sam
S
Division of Cardiology, Beth Israel Medical Center, University Hospital and Manhattan Campus for the Albert Einstein College of Medicine, New York, NY, USA. shanon@chpnet.org
Seewald
Randy M
RM
Yang
Felix
F
Schweitzer
Paul
P
Rosman
Jonathan
J
D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008691:Methadone / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D009292:Narcotic Antagonists; D008691:Methadone