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Review
. 2013 Dec;4(4):229-35.
doi: 10.1016/j.jcdr.2013.10.001. Epub 2013 Nov 16.

Methadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the tale?

Sobia Mujtaba  1 , Jorge Romero  2 , Cynthia C Taub  3
Affiliations
Review

Methadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the tale?

Sobia Mujtaba et al. J Cardiovasc Dis Res. 2013 Dec.

Abstract

Methadone is a drug that has found widespread utility in the management of opioid addiction and pain. Along with its popularity, methadone has also earned an infamous reputation for causing prolongation of the QT interval and an increased risk of torsades de pointes. In this article we will give a brief overview of the long QT syndromes, followed by an in-depth look at the current pathophysiologic mechanisms of methadone induced QT prolongation, a review of the existing literature and the current concepts regarding the prevention and management of methadone induced torsades de pointes. In addition, we explore the idea and implications of a genetic link between methadone induced prolongation of the QT interval and torsades de pointes.

Keywords: Methadone; Pharmacogenetics; QT-prolongation; Torsades de pointes.

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Figures

Fig. 1
Fig. 1
12-Lead surface electrocardiogram depicting normal sinus rhythm with polymorphic premature ventricular contractions. Also QTc is markedly prolonged (657 ms).
Fig. 2
Fig. 2
Telemetry recording of an episode of torsade de pointes.
See this image and copyright information in PMC

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