title: Methadone, QTc interval prolongation and torsade de pointes: Case reports offer the best understanding of this problem.
abstract: We reviewed the literature and found 31 adult cases and 1 newborn case of methadone-associated QTc interval prolongation and/or torsade de pointes (TdP). Parametric statistics may not be useful in studying this issue because methadone-associated TdP is a very rare event and, hence, "an extreme outlier" consistent with scalable randomness. We may have to rely upon narrative medicine in the form of case reports with all its limitations and hazards to provide our best understanding. We report risk factors for methadone-associated QTc interval prolongation and TdP based on review of published case reports. We believe both drug manufacturers and the FDA would better serve our patients and inform clinicians if they more readily reported drug-induced outliers such as methadone-associated TdP using a case report format.
authors.affiliation: Departments of Psychiatry and Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: W Victor R
authors.initials: WV
authors.lastname: Vieweg
authors.forename: Mehrul
authors.initials: M
authors.lastname: Hasnain
authors.forename: Robert H
authors.initials: RH
authors.lastname: Howland
authors.forename: Thomas
authors.initials: T
authors.lastname: Clausen
authors.forename: Jayanthi N
authors.initials: JN
authors.lastname: Koneru
authors.forename: Christopher
authors.initials: C
authors.lastname: Kogut
authors.forename: Ericka L Breden
authors.initials: EL
authors.lastname: Crouse
authors.forename: Jules C
authors.initials: JC
authors.lastname: Hancox
authors.forename: Antony
authors.initials: A
authors.lastname: Fernandez
authors.forename: Ananda K
authors.initials: AK
authors.lastname: Pandurangi
keywords: Drug-induced QTc interval prolongation; methadone; risk factors; torsade de pointes