TY - JOUR
T1 - The effect of oral methadone on the QTc interval in advanced cancer patients
T2 - A prospective pilot study
AU - Reddy, Suresh
AU - Hui, David
AU - Osta, Badi El
AU - De La Cruz, Maxine
AU - Walker, Paul
AU - Palmer, J. Lynn
AU - Bruera, Eduardo
PY - 2010/1/1
Y1 - 2010/1/1
N2 - Background: Recent reports suggest that high doses of methadone may prolong QTc interval and occasionally cause torsades de pointes; however, few of these studies involved the palliative care population. Objective: The purpose of this study was to determine the effect of initiation of methadone on QTc interval in patients with cancer pain seen at the palliative care setting. Methods: We enrolled 100 patients with cancer in this prospective study. Patients were followed clinically and electrocardiographically for QTc changes at baseline, 2, 4, and 8 weeks. Contributing factors for QTc prolongation such as medications, cardiovascular diseases, and electrolytes disturbances were documented. QTc prolongation was defined as greater than 430ms in males and greater than 450ms in females, and significant QTc prolongation was defined as QTc interval greater than 25% increase from baseline or 500ms or more. Results: Electrocardiographic (ECG) assessments were available for 100, 64, 41, and 27 patients at baseline, 2-, 4-, and 8-week follow-up, respectively. At baseline prior to initiation of methadone, 28 (28%) patients had QTc prolongation. Clinically significant increase in QTc occurred in only 1 of 64 (1.6%) patients at week 2, and none at weeks 4 and 8. There was no clinical evidence of torsades de pointes, ventricular fibrillation, or sudden death. QTc prolongation was more frequent among patients with increased baseline QTc interval. Conclusions: Baseline QTc prolongation was common, whereas significant QTc interval 500ms or more after methadone initiation rarely occurred, with no evidence of clinically significant arrhythmias. This study supports the safety of methadone use for pain control in patients with advanced cancer in the palliative care setting.
AB - Background: Recent reports suggest that high doses of methadone may prolong QTc interval and occasionally cause torsades de pointes; however, few of these studies involved the palliative care population. Objective: The purpose of this study was to determine the effect of initiation of methadone on QTc interval in patients with cancer pain seen at the palliative care setting. Methods: We enrolled 100 patients with cancer in this prospective study. Patients were followed clinically and electrocardiographically for QTc changes at baseline, 2, 4, and 8 weeks. Contributing factors for QTc prolongation such as medications, cardiovascular diseases, and electrolytes disturbances were documented. QTc prolongation was defined as greater than 430ms in males and greater than 450ms in females, and significant QTc prolongation was defined as QTc interval greater than 25% increase from baseline or 500ms or more. Results: Electrocardiographic (ECG) assessments were available for 100, 64, 41, and 27 patients at baseline, 2-, 4-, and 8-week follow-up, respectively. At baseline prior to initiation of methadone, 28 (28%) patients had QTc prolongation. Clinically significant increase in QTc occurred in only 1 of 64 (1.6%) patients at week 2, and none at weeks 4 and 8. There was no clinical evidence of torsades de pointes, ventricular fibrillation, or sudden death. QTc prolongation was more frequent among patients with increased baseline QTc interval. Conclusions: Baseline QTc prolongation was common, whereas significant QTc interval 500ms or more after methadone initiation rarely occurred, with no evidence of clinically significant arrhythmias. This study supports the safety of methadone use for pain control in patients with advanced cancer in the palliative care setting.
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U2 - 10.1089/jpm.2009.0184
DO - 10.1089/jpm.2009.0184
M3 - Article
C2 - 19824814
AN - SCOPUS:74549168886
SN - 1096-6218
VL - 13
SP - 33
EP - 38
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 1
ER -