QTc Prolongation in Acute Methadone Poisoning
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 3 No. 4(Autumn) (2013),
2 December 2013
,
Page 135-139
https://doi.org/10.22037/ijmtfm.v3i4(Autumn).4559
Abstract
Background:Methadone is considered as a good choice for maintenance treatment program (MMTP) in opioid addicted individuals. QT interval prolongation was reported previously in methadone chronic usersespecially in high dose prescription. QT-interval prolongation predisposes patients to lethal dysrhythmia. This is a report of corrected QT(QTc) prolongation due to acute methadone poisoning. To the best of our knowledge, in review of literatures, there is no previous report of QTc prolongation in cases that are not on chronic methadone therapy.
Case Report: The patient was a 20 years old man who has occasionally used opium and ice since 8 month before admission. One night before admission he consumed ice and found psychotic state so he was referred to the addiction treatment center and they put him on methadone maintenance treatment with high dose of methadone. After 40 minutes the patient was drowsy and then hypopnea was started. The patient was referred to the hospital and resuscitation was done after naloxone prescription. After stabilizing general conditions the electrocardiograph shows QTc prolongation which was returned to normal status after 2 days. After 5 days the patient was transferred to psychiatric service with normal sinus rhythm and stable condition.
Conclusion:QT interval prolongation in chronic methadone maintenance therapy is defined previously especially in patients on other drugs that interact with the CYP3A4 isoenzyme system and who are on high dose methadone treatment, but it seems that acute methadone intoxication also may prolong the QT interval which should be investigated in future studies.
- Methadone
- Arrhythmia
- ECG Changes
How to Cite
References
Nelson LS, Olsen D. Opioids. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank'sToxicologic Emergencies, 9th edit. New York: McGraw-Hill, 2011:559-578.
Dole VP,Wander MA.Medical treatment for diacetylmorphine(heroin)addiction-A clinical trial with methadone hydrochloride. JAMA.1965;193:464-650.
KrachSB,Stephen S.Toxicology and pathology of death related to methadone:retrospectivereview.West J Med.2000;172:11-14.
Martell BA,Arnsten JH,Krantz MJ.Impact of methadone treatment on cardial repolarization and conduction in opioid users.Am J cardiol. 2005;95:915-918.
Krantz MJ,Martin J,Stimmel B.QTC interval screening in methadone treatment.Ann Intern med.2009;150;387-395.
Daley AC, Marlatt GA,Lewinson JH, Ruiz P, Millman RB, Langrod JG. Substance Abuse (A Comprehensive Textbook). 4th edit. Boston:Williams& Wilkin. 2005;674-681.
Brugal MT, Domingo-Salvany A, Puig R, Barrio G, Garcia de Olalla P, de la Fuente L. Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain. Addiction. 2005;100:981–989.
Gibson A, Degenhardt L, Mattick RP, Ali R, White J, O’Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008;103:462–468.
SadockBj, SadockVA.Kaplan. Comprehensive textbook of psychiatry. 8th ed.Philadelphia: Lippincott Wiliams and Wilkins. 2005;1284-1289.
Kleber HD, Methadone Maintenance 4 Decades Later. JAMA. 2008;300:2303-2305.
Cruciani RA. Methadone: To ECG or not to ECG...That is still the question. J Pain Symptom Manage. 2008;3(6):545–52.
Katchman AN, Ebert SN, McGroay KA, Woosley RL. Methadone blocks HERG current in transfercted HEK cells. The pharmacologist. 2001;4(3):98-102.
Huber A, Ling W, Eradis J, Comparison of the effects of methadone and LAAM on the electrocardiogram. Drug Alcohol Depend 2001;6(3):70-75.
Viskin S. long QT syndromes and torsades de pointes. Lancet 1999;5(4):1625-1633.
Walker PW, Klein D, Kasza L. High dose methadone and ventricular arrhythmia: a report of three cases. Pain 2003;103:321-324.
Sticherling C, Schaer BA, Ammann P. Methadone induced torsade de pointes tachycardias. Swiss Med Wkly 2005;13(5):282-285.
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