Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Feb 23;14(2):e22534.
doi: 10.7759/cureus.22534. eCollection 2022 Feb.

Diphenhydramine-Induced Torsade De Pointes With Pharmacological Cardioversion in a Patient With Methadone-Induced QT Prolongation

Jamie P Hoffman  1 , Andrew A Serdiuk  1 , Allan R Escher Jr  2 , Bruno Bordoni  3 , Raymond Evans  1
Affiliations
Case Reports

Diphenhydramine-Induced Torsade De Pointes With Pharmacological Cardioversion in a Patient With Methadone-Induced QT Prolongation

Jamie P Hoffman et al. Cureus. .

Abstract

The anesthetic management of patients with chronic pain requires a thorough understanding of the physiologic changes resulting from long-term exposure to opioids, as well as a firm comprehension of the pharmacodynamic and pharmacokinetic properties of these medications. We present the case of a 60-year-old woman on methadone therapy presenting for cervical laminectomy and fusion. After intraoperative dysrhythmias, she underwent pharmacological cardioversion from torsade de pointes. This occurred intraoperatively after receiving 25 mg of intravenous diphenhydramine to attenuate erythema thought to be secondary to antibiotic administration. The use of a routine antihistamine may present a torsadogenic reaction in the setting of methadone maintenance treatment.

Keywords: chronic pain management; diphenhydramine; magnesium; methadone; naranjo scale; opioid use disorder (oud); pharmacologic cardioversion; qt interval prolongation; sevoflurane; torsade de pointes.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Electrocardiogram demonstrating TdP preceded by the classical short-long-short RR interval.
TdP: torsades de pointes; RR: time elapsed between two successive R-waves of the QRS signal on the electrocardiogram
See this image and copyright information in PMC

References

    1. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Mil Med. 2016;181:397–399. - PubMed
    1. Sevoflurane, but not propofol, significantly prolongs the Q-T interval. Kleinsasser A, Kuenszberg E, Loeckinger A, Keller C, Hoermann C, Lindner KH, Puehringer F. Anesth Analg. 2000;90:25–27. - PubMed
    1. Torsade de pointes associated with very-high-dose methadone. Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Ann Intern Med. 2002;137:501–504. - PubMed
    1. Substance Abuse and Mental Health Services Administration. N-SSATS. Rockville, MD: Substance Abuse and Mental Health Services Administration; [ Feb; 2022 ]. 2019. Behavioral health barometer: United States, volume 5: indicators as measured through the 2017 National Survey on Drug Use and Health and the National Survey of Substance Abuse Treatment Services. - PubMed
    1. Diphenhydramine induced QT prolongation and torsade de pointes: an uncommon effect of a common drug. Husain Z, Hussain K, Nair R, Steinman R. https://pubmed.ncbi.nlm.nih.gov/20865683/ Cardiol J. 2010;17:509–511. - PubMed

Publication types

LinkOut - more resources