Key result
Sustained release oral morphine reduced the QTc interval, prevented further arrhythmias, and maintained abstinence in a patient with methadone-associated Torsades de Pointes.
Case Report (n=1)
Sustained release oral morphine may serve as an effective and safe alternative to methadone in patients with opioid-use disorder who develop methadone-induced Torsades de Pointes.
May warrant trial as methadone alternative in TdP; hypothesis-generating and should not yet change practice.
In most settings, approved medications for the treatment of opioid-use disorder include methadone and buprenorphine/naloxone, and in some settings, naltrexone. We present a case in which methadone administration was associated with an in-hospital episode of Torsades de Pointes in a patient who was subsequently maintained on sustained release oral morphine (SROM) for treatment of his opioid-use disorder. This transition was made in the context of long-term compliance to methadone maintenance, and with a previous adverse reaction to buprenorphine/naloxone precluding its use. The change to SROM, supported by emerging evidence, resulted in a reduction in the patient's measured QTc interval, prevention of further arrhythmias and continued abstinence from illicit opioid-use. In this context, we believe careful consideration should be given to the use of SROM.
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Walton et al. (2015) conducted a case report in Opioid-use disorder post Torsades de Pointes cardiac arrest (n=1). Sustained release oral morphine (SROM) vs. Methadone was evaluated on QTc interval reduction, prevention of further arrhythmias, and continued abstinence from illicit opioid-use. Sustained release oral morphine reduced the QTc interval, prevented further arrhythmias, and maintained abstinence in a patient with methadone-associated Torsades de Pointes.
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