title: Clinical Presentation and the Outcome of Therapy in a Cohort of Patients with Methadone Toxicity in Iran.
abstract: BACKGROUND
  Agonist maintenance therapy with methadone is amongst the preferred remedies for treating opioid dependence and is increasingly supported by the regional governments in this part of the world. In this study we have investigated the clinical manifestations and factors affecting the outcome of therapy in patients with methadone poisoning in a Middle-Eastern (Iranian) referral tertiary care University hospital.
  
  
  METHODS
  In this prospective and descriptive-analytic study which was done in a tertiary care and referral University hospital in Iran (2012-2013) all of the admitted patients with a clear and reliable history of methadone poisoning (n=433) were included and demographic data, Clinical status on admission including Glasgow Coma Scale (GCS) score, time elapsed from ingestion to hospital admission, average dose of naloxone used, any history of psychiatric disorder, type of toxic exposure, co ingestion of other medication, hospitalization time and the outcome were recorded and statistically analyzed.
  
  
  RESULTS
  The average length of hospital stay was 33 ± 26 hours. 80.1% of patients had ingested methadone alone, and 90.3% survived. Complications were pulmonary edema (7%), aspiration pneumonia (1.4%), generalized tonic colonic seizure (0.9%), and renal failure (0.5%). GCS, systolic blood pressure and respiratory rate were lower in fatal cases and GCS had prognostic value for the outcome of therapy in methadone intoxicated patients. Patients with higher GCS on admission had better outcome [OR =0.47 (95% CI: 0.38-0.580); P value< 0.0001].
  
  
  CONCLUSIONS
  Admission time GCS score maybe considered as an important predictor for the outcome of therapy in methadone poisoning.
authors.affiliation: Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Eizadi-Mood
authors.affiliation: Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Yaraghi
authors.affiliation: Department of Clinical Toxicology, Noor and Ali-Asghar [PBUH] University hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sharifian
authors.affiliation: Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Awat
authors.initials: A
authors.lastname: Feizi
authors.affiliation: Department of Clinical Toxicology, Noor and Ali-Asghar [PBUH] University hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahrang
authors.initials: M
authors.lastname: Hedaiaty
authors.affiliation: Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Sabzghabaee
keywords: Methadone; Opiate Substitution Therapy; Overdose