Key result
Methadone prolongs the QT interval and increases risk of life-threatening torsades de pointes.
Why the study?
Methadone use carries risks of variable pharmacokinetics and potentially fatal QT prolongation and torsades de pointes that require close monitoring.
Supports QT monitoring with methadone; leaves open precise risk quantification in prospective cohorts.
An alternative analgesic to morphine is methadone, which is used to control chronic pain and is used in opioid rehabilitation treatment programs due to methadone having a long half-life and being relatively inexpensive as compared to extended-release forms of morphine. Despite its benefits, methadone accumulates in adipose tissue due to being lipophilic, binds strongly to plasma proteins, and is metabolized in the liver by the cytochrome P450 system causing methadone levels to be variable and subject to influence according to the individual body compositions and concurrent use of cytochrome P450 inhibitors. In addition to methadone being able to cause both respiratory and central nervous system depression, methadone can also prolong the QT interval and cause potentially life-threatening arrhythmias including torsades de pointes. The susceptibility of unintentional overdosing of methadone due to its varied pharmacologic properties and potentially fatal induction of arrhythmias may cause the risks of methadone use to outweigh its benefits and therefore must be closely monitored.
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Treece et al. (2018) conducted a review in Methadone-Induced QT Prolongation and Torsades. Methadone was evaluated on QT prolongation and torsades de pointes. Methadone use can prolong the QT interval and cause potentially life-threatening arrhythmias including torsades de pointes, requiring close monitoring.