Comparison of QTc Interval Prolongation for Patients in Methadone Versus Buprenorphine Maintenance Treatment: A 5-Year Follow-Up

Abstract

The authors investigated whether patients receiving buprenorphine maintenance treatment (BMT) will have corrected QT (QTc) prolongation after taking buprenorphine for an extended period of time. They also compared QTc prolongation for patients in methadone maintenance treatment (MMT) versus BMT to determine which medication is the better option for patients with heart disease. A retrospective chart review study of 73 patients in BMT and 55 patients in MMT was performed. A linear regression model with a one-sided P value was used for data analysis. The MMT group had statistically significant prolongation of QTc compared with the BMT group (F = 3.94, P = .0001). Being diagnosed with congestive heart failure and taking methadone were the only individual variables that showed a statistically significant association with a QTc prolongation > 500 ms. The model as a whole showed statistical significance (F = 5.203, P = .007). Being diagnosed with congestive heart failure was the only individual variable that showed a statistically significant association with mortality. The model as a whole also showed statistical significance (F = 17.15, P = .000). This study supports previous findings that methadone may be associated with QTc prolongation, whereas buprenorphine may not. This study has the advantage of confirming that QTc prolongation persists in patients in MMT but not in those in BMT over an extended period of time (i.e., 5 years). Buprenorphine might a better first-line opioid maintenance treatment for patients with heart disease because buprenorphine was not associated with QTc prolongation. Patients in BMT may not need to be screened routinely for QTc prolongation.

Opioids and Cardiac Arrhythmia: A Literature Review

“…Supporting this conclusion was another study on 73 patients on BMT and 55 patients on MMT. In this study, Fareed et al [32] compared QTc prolongation in both groups over a 5-year period; their results demonstrated that unlike methadone, buprenorphine has no significant effect on QTc prolongation and is a safer drug for OMT than methadone. Also in 12 patients who had QT prolongation and ventricular arrhythmia due to methadone, changing methadone to buprenorphine in 3 of them made the QT interval normal and augmented the preference for buprenorphine over methadone [33].…”

Management of opioid use disorders: a national clinical practice guideline

“…[43][44][45] Regarding adverse events, only a minor effect on corrected QT (QTc) interval duration has been reported with therapeutic doses of buprenorphine-naloxone, without proarrhythmic effects. 46,47 Conversely, methadone can increase the risk of a rare but fatal ventricular arrhythmia (torsades de pointes) because of its substantial QT-prolonging effects, especially at higher doses. 47 Case series have reported that transitioning patients taking methadone who were experiencing torsades de pointes to buprenorphine corrected the condition.…”

Chemokine IP-10 is correlated with cardiac responses and status of infection with HIV and HCV in methadone maintenance patients

“…Because QT prolongation can also be contributed by the methadone per se or HCV infection [7][8][9][10], we further verified the role of IP-10 on QTc through intraperitoneal injection of IP-10 (100 ng/g) to mice. The results showed that IP-10 did cause a significant increase in current QTc (data not shown).…”