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QTc Interval Screening in Methadone Treatment
- Mori J. Krantz, MD;
- Judith Martin, MD;
- Barry Stimmel, MD;
- Davendra Mehta, MD; and
- Mark C.P. Haigney, MD
- From the University of Colorado and the Colorado Prevention Center, Denver, Colorado; BAART Turk Street Clinic, San Francisco, California; Mount Sinai School of Medicine, New York, New York; and Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Abstract
Description: An independent panel developed cardiac safety recommendations for physicians prescribing methadone.
Methods: Expert panel members reviewed and discussed the following sources regarding methadone: pertinent English-language literature identified from MEDLINE and EMBASE searches (1966 to June 2008), national substance abuse guidelines from the United States and other countries, information from regulatory authorities, and physician awareness of adverse cardiac effects.
Recommendation 1 (Disclosure): Clinicians should inform patients of arrhythmia risk when they prescribe methadone.
Recommendation 2 (Clinical History): Clinicians should ask patients about any history of structural heart disease, arrhythmia, and syncope.
Recommendation 3 (Screening): Obtain a pretreatment electrocardiogram for all patients to measure the QTc interval and a follow-up electrocardiogram within 30 days and annually. Additional electrocardiography is recommended if the methadone dosage exceeds 100 mg/d or if patients have unexplained syncope or seizures.
Recommendation 4 (Risk Stratification): If the QTc interval is greater than 450 ms but less than 500 ms, discuss the potential risks and benefits with patients and monitor them more frequently. If the QTc interval exceeds 500 ms, consider discontinuing or reducing the methadone dose; eliminating contributing factors, such as drugs that promote hypokalemia; or using an alternative therapy.
Recommendation 5 (Drug Interactions): Clinicians should be aware of interactions between methadone and other drugs that possess QT interval–prolonging properties or slow the elimination of methadone.
Article and Author Information
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Note: Clinical practice guidelines/recommendations are intended to enhance patient care and do not supplant clinical judgment. This guideline, therefore, may not apply to all patients or clinical scenarios.
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Disclaimer: The views, opinions, and content of this document are those of the authors and other referenced sources and do not necessarily reflect the views, opinions, or policies of the Department of Defense, the CSAT, the Substance Abuse and Mental Health Services Administration, or any other part of the U.S. Department of Health and Human Services.
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Acknowledgment: The authors thank Sara Alan for administrative support, William Baker for manuscript review, and Laura Governale from the FDA Center for Drug Evaluation and Research Office of Surveillance and Epidemiology for assistance with data acquisition.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Mori J. Krantz, MD, Colorado Prevention Center, 789 Sherman Street, Suite 200, Denver, CO 80203.
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Current Author Addresses: Dr. Krantz: Colorado Prevention Center, 789 Sherman Street, Suite 200, Denver, CO 80203.
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Dr. Martin: BAART Turk Street Clinic, 433 Turk Street, San Francisco, CA 94102.
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Drs. Stimmel and Mehta: Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029-6500.
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Dr. Haigney: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, A3060, Bethesda, MD 20814.
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