Methadone Risks
Narcotic (Opioid) treatment programs are very common in the United States and methadone clinics seem to be popping up more frequently.
There is mounting evidence that methadone is associated with serious heart problems and a multidisciplinary team has recently made new recommendations for practitioners and patients.
There are an estimated 250,000 patients receiving methadone in opioid treatment programs as well as the nearly 720,000 patients receiving methadone for chronic pain through U.S. retail pharmacies by private physicians.
This review of the evidence suggested that methadone, both oral and intravenous, is associated with a heart condition called prolonged QT syndrome. This can lead to a life threatening arrhythmia referred to as torsade de pointes.
The panel issued the following specific recommendations in 5 key clinical areas:
Recommendation 1 (Disclosure): When clinicians prescribe methadone, they should inform patients about arrhythmia risk.
Recommendation 2 (Clinical History): Clinicians should ask patients about any history of structural heart disease, arrhythmia, or syncope.
Recommendation 3 (Screening): All patients should have a pretreatment electrocardiogram (ECG) to measure QTc interval and a follow-up ECG within 30 days and each year. If the methadone dosage is greater than 100 mg/day, or if patients have unexplained syncope or seizures, additional ECG is recommended.
Screening with ECG may also be done as indicated for patients receiving methadone who have multiple risk factors for QTc interval prolongation, such as a family history of long QT syndrome or early sudden cardiac death or electrolyte depletion. Screening is also recommended when a cytochrome P450 inhibitor or other QTc interval–prolonging drug, including cocaine, is started.
Recommendation 4 (Risk Stratification): For patients in whom the QTc interval is between 450 and 500 milliseconds, the potential risks and benefits should be discussed, and they should be monitored more frequently.
If the QTc interval is greater than 500 milliseconds, discontinuing or decreasing the methadone dose should be considered, as well as eliminating other contributing factors such as drugs that cause hypokalemia. Use of an alternative therapy may be indicated.
Recommendation 5 (Drug Interactions): Clinicians should be knowledgeable concerning interactions between methadone and other drugs that tend to prolong the QT interval or to slow the elimination of methadone.
There is mounting evidence that methadone is associated with serious heart problems and a multidisciplinary team has recently made new recommendations for practitioners and patients.
There are an estimated 250,000 patients receiving methadone in opioid treatment programs as well as the nearly 720,000 patients receiving methadone for chronic pain through U.S. retail pharmacies by private physicians.
This review of the evidence suggested that methadone, both oral and intravenous, is associated with a heart condition called prolonged QT syndrome. This can lead to a life threatening arrhythmia referred to as torsade de pointes.
The panel issued the following specific recommendations in 5 key clinical areas:
Recommendation 1 (Disclosure): When clinicians prescribe methadone, they should inform patients about arrhythmia risk.
Recommendation 2 (Clinical History): Clinicians should ask patients about any history of structural heart disease, arrhythmia, or syncope.
Recommendation 3 (Screening): All patients should have a pretreatment electrocardiogram (ECG) to measure QTc interval and a follow-up ECG within 30 days and each year. If the methadone dosage is greater than 100 mg/day, or if patients have unexplained syncope or seizures, additional ECG is recommended.
Screening with ECG may also be done as indicated for patients receiving methadone who have multiple risk factors for QTc interval prolongation, such as a family history of long QT syndrome or early sudden cardiac death or electrolyte depletion. Screening is also recommended when a cytochrome P450 inhibitor or other QTc interval–prolonging drug, including cocaine, is started.
Recommendation 4 (Risk Stratification): For patients in whom the QTc interval is between 450 and 500 milliseconds, the potential risks and benefits should be discussed, and they should be monitored more frequently.
If the QTc interval is greater than 500 milliseconds, discontinuing or decreasing the methadone dose should be considered, as well as eliminating other contributing factors such as drugs that cause hypokalemia. Use of an alternative therapy may be indicated.
Recommendation 5 (Drug Interactions): Clinicians should be knowledgeable concerning interactions between methadone and other drugs that tend to prolong the QT interval or to slow the elimination of methadone.
Labels: cardiovascular, methadone
posted by Anonymous at 5:30 AM
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