METHADONE USE PRESENTS HEART RISK EVEN AT THERAPEUTIC DOSES

[rlsseattle]

Newly Released Study. I am NOT a doctor, so make of it what you will. Link to full story below.

Quoted here from MedPage. Full story at :

http://www.medpagetoday.com/Psychiatry/ ... ns/dh/7959

Methadone Use May Pose Sudden Death Risk
By Charles Bankhead, Staff Writer, MedPage Today
Published: January 14, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news

PORTLAND, Ore., Jan. 14 -- Methadone-associated sudden cardiac death is a risk even when used at appropriate doses to treat pain or drug addiction, investigators here concluded.
...

There were no clear cardiac causes for 77% of sudden deaths associated with therapeutic methadone doses, Sumeet S. Chugh, M.D., of Oregon Health and Science University, and colleagues, reported in the January issue of The American Journal of Medicine.

In contrast, 60% of sudden deaths unrelated to methadone use involved cardiac abnormalities.

"The significantly lower prevalence of cardiac disease in the case group implicates methadone, even at therapeutic levels, as a likely cause of sudden death," the authors concluded. "These findings point toward an association between methadone and occurrence of sudden death in the community."

Read the whole article at link above

[Aiken]

Hmm, I'm wishing for a lot more information than the article offers.

I don't know what oral dose would typically produce a "<1 mg/L, average 0.48 mg/L" blood level. The notion of a "therapeutic dose" describes a pretty wide range of dosing, depending on the therapy and the patient.

I'm also curious how methadone compares to other opioids, opioid analogues, and synthetic opioids, with regard to the "blockade of the cardiac potassium ion channel". If they all do it, that would be good to know.

I do know that even 7.5mg methadone depressed my respiration the first night I took it, and probably depressed my cardiac activity as well. Scared me. I'd like to know what percent of the fatalities occurred amongst people who were just beginning their therapy.

Tolerance is a huge factor as well. That 7.5mg dose that frightened me would be no big deal to someone who had previously been on multiple doses of oxycodone per day, for instance.

Anyone here have access to the American Journal of Medicine? Maybe the original paper has answers to some of these questions.

[SquirmingSusan]

That is scary! I would assume that the prolonged QT interval would show up on an EKG? I just had one of those before my surgery last month, and apparently it was good, but that does make me nervous.

[FidgetBoy]

I've seen very significant methadone-induced torsades a few times in my career-- but in both cases, they were patients on very large doses of methadone. >150 mg per day. I found a link for a really nice paper on QTc prolongation and methadone. Those of you on methadone should read it:

http://www.smw.ch/docs/pdf200x/2005/19/smw-10939.pdf

This paper basically states that the 2 scenarios that are most important predictors of QTc prolongation are: 1) adding other QTc prolonging meds on top of your methadone (a list can be found at www.qtdrugs.com) and/or 2) when you have low potassium levels in your blood.

Just so everyone knows-- this is NOT just a methadone issue-- there are quite a few meds on the market that can cause EKG changes.

[SquirmingSusan]

Thanks Josh, that was a good article. Unfortunately the link to the meds that prolong QT doesn't have a list of such drugs that I could find.

[ViewsAskew]

I add my thanks, Josh. I appreciate greatly that you are willing to offer your expertise to us like this, as I imagine many of us do.

Susan, I couldn't find anything there, either. I did a search and found this great list: http://www.arizonacert.org/medical-pros ... ist-01.cfm

In case that doesn't work (it is a pop-up), here is the direct site: http://www.arizonacert.org/medical-pros ... -lists.htm#

[SquirmingSusan]

Excellent, Ann. And a relief that even with all the meds I do take, I don't take any of those except the methadone.

Thanks.