REVIEW ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 66-75

Comprehensive review on methadone-induced QT prolongation and torsades

Jennifer M Treece1, Mohammad Al Madani2, George El Khoury3, Ola Khraisha2, James E Martin4, Steven J Baumrucker5, Christopher A Neglia6, Timir K Paul7
1 Departments of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
2 Department of Interventional Cardiology, Kings Daughter Medical Center, Portsmouth, Ohio and Ashland, Kentucky, USA
3 Division of Cardiology, Heart Clinic of Hammond, Hammond, Louisiana, USA
4 Department of Family Medicine, Lincoln-Debusk College of Osteopathic Medicine, Kingsport, TN, USA
5 Department of Hospice and Palliative Medicine, Wellmont Health System, Kingsport, TN, USA
6 Holston Medical Group, Kingsport, TN, USA
7 Department of Cardiology, East Tennessee State University, Johnson City, TN, USA

Correspondence Address:
Timir K Paul
East Tennessee State University, 329 N State of Franklin, Johnson City 37604, TN
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpp.JPP_163_17

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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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