Corrected QT Interval Prolongation in Pediatric and Young Adult Patients on Methadone for Cancer-Related Pain

Context: Methadone has been reported to prolong the corrected QT (QTc) interval and increase the risk of torsades de pointes. Objectives: Our study examined the frequency of QTc prolongation among pediatric and young adult patients starting methadone for cancer pain. Methods: All patients followed a standardized protocol. Electrocardiograms (ECGs) were obtained at baseline (methadone starting day to 14 days prior), 1–2 weeks, and 4–6 weeks later. QTc values were manually calculated using the Bazett formula. QTc prolongation was defined as ≥460 milliseconds (ms) for prepubertal children, ≥470 ms for pubertal males, and ≥480 ms for pubertal females. Results: Baseline ECGs were completed in 42 patients. Follow-up ECGs were completed in 38 of 42 (91%) and 31 of 42 (74%) patients at 1–2 weeks and 4–6 weeks, respectively. No patients had prolongation of the QTc at baseline, and 1 of 38 (3%) patients had a prolonged QTc at weeks 1–2. This patient had a history of prolonged QTc that the family did not initially report. No patients had prolongation of the QTc at weeks 4–6. No patients had torsades de pointes or ventricular fibrillation, and none died suddenly. Median (interquartile range [IQR]) baseline QTc was 391 (377–400) ms; median (IQR) 1–2 week follow-up QTc was 399 (374–411) ms (P = .05), and median (IQR) 4–6 week follow-up QTc was 393 (379–423) ms (P = .01). Conclusion: Clinically significant prolongation of the QTc interval occurred only in one patient who had a history of prolonged QTc. Prolonged QTc is rare in this population.