Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article

Etaee, Farshid; Tobin, Morgan; Vuppala, Suchith; Komaki‬, Alireza; Delisle, Brian P.; Biase, Luigi Di; Catanzaro, John N.; Elayi, Claude S.

doi:10.1007/s10840-021-01072-1

Cited by 4 publications

(4 citation statements)

References 105 publications

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“…These women are younger than the general population and are traditionally considered to be at low risk for acute CV events. 23 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 Pregnancy, in and of itself, increases the risk of CV events due to the normal pregnancy-related changes in CV hemodynamics and function, 8 , 9 however we have demonstrated that substance use in pregnancy increases that risk further. Ultimately, there are no studies to date directly comparing the pathophysiologic effect of substance use on the CV system in the pregnant and nonpregnant state, but it is possible that the combined, additive CV hemodynamic changes from pregnancy in addition to substance use may exceed what the CV system can tolerate and result in an increased susceptibility for acute CV events among substance user who are pregnant.…”

Section: Discussionmentioning

confidence: 59%

“…Opioid use alters cardiac physiology primarily through abnormal cardiac signaling by modifying electrical conduction and contractility, with a strong association with AMI, stroke, arrhythmia, CM/HF, cardiac arrest, and mortality. 27 , 28 , 29 Only an increased association with AMI, CM/HF, and cardiac arrest were increased in women who abused opioids at delivery hospitalization. Opioids, as well as other substances with an intravenous route of administration, such as methamphetamine and cocaine, have an established association with endocarditis.…”

Section: Discussionmentioning

confidence: 95%

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Substance Use in Pregnancy and its Association With Cardiovascular Events

Evans,

Wu,

Mamas

et al. 2023

JACC: Advances

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 95%

Substance Use in Pregnancy and its Association With Cardiovascular Events

Evans,

Wu,

Mamas

et al. 2023

JACC: Advances

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“…Methadone has also been associated with QTc prolongation and this risk has been shown to be further elevated in those that also use amphetamines. 18 QTc values ≥450 ms are generally considered prolonged, although some have also used a higher threshold of ≥500 ms. 19,20 This patient was noted to have an initial QTc of 453 ms and then 481 ms on his subsequent visit, although these are likely overestimations secondary to his elevated heart rate (>110), and no abnormal rhythm was identified on either assessment. 21 Psychostimulants have been shown to enhance antinociception when combined with morphine and methadone in the setting of treating opiate-induced cognitive dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Possible Delay in Symptomatology of a Methadone Overdose in a Patient Ingesting an Energy Drink and Dextroamphetamine/Amphetamine

Weant

Hall

2022

Journal of Pharmacy Practice

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Introduction: Methadone is a mu-opioid agonist with a delayed time to peak concentration that requires an extended period of monitoring following an overdose. Available data suggests that the combination of psychostimulants with methadone may augment antinociception and tolerance to opioids. Case Report: A 26-year-old male (83.9 kg) presented to the ED approximately 1 hour after unintentionally ingesting 200-250 mg of liquid methadone and an energy drink, along with 20 mg of dextroamphetamine/amphetamine prior to the event. Vital signs were: blood pressure (BP), 143/91 mmHg; heart rate (HR), 74; respirations (RR), 16; oxygen saturation 95% on room air. His urine drug screen was positive for amphetamines and methadone. Patient was monitored for 4 hours with no change in status and was discharged home. Approximately 26 hours later patient was found cyanotic and apneic. Patient was given 2 mg of naloxone and awoke with normal mental status. On presentation the patient’s vital signs were: BP, 114/70 mmHg; HR, 114; RR 16; oxygen saturation 94% on 3 liters nasal cannula. During his ED stay, he required 2 doses of naloxone secondary to oxygen desaturation and was admitted to the hospital. His repeat urine drug screen was positive for amphetamines and methadone. The patient was discharged the following day. Discussion: This case illustrates an unintentional methadone overdose combined with the intentional ingestion of an energy drink and dextroamphetamine/amphetamine that possibly masked the toxicity for over 24 hrs. Monitoring parameters for methadone overdoses may need re-evaluation in the setting of the co-ingestion of a stimulant.

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“…Aging is also associated with alterations in the amount of sympathetic and parasympathetic tone, that alters myocardial repolarization and the duration of the QTc (27). Despite the interaction with other factors, opioid drugs, in general, can uniquely affect the ECG and lead to the development of cardiac arrhythmias and QTc interval prolongation being the most significant side effect (28). The mechanism of QTc prolongation due to opioid use is explained by inhibiting the Human ether a go-go related gene(hERG) (29).…”

Section: Factors Associated With Sinus Bradycardiamentioning

confidence: 99%

Prevalence and factors associated with electrocardiographic abnormalities among adults attending Methadone Assisted Therapy in Dodoma, central Tanzania

Kalungi

Rwiza²,

Nyundo

2022

Preprint

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Background Patients with opioid use disorder are at a higher cardiovascular risk due to the effect of opioids on the cardiovascular system. Cardiac conduction abnormalities, electrical activity impairment, cardiac arrhythmias, and ventricular hypertrophy are reported in the opioid population. Objective This study aimed to assess the prevalence and factors associated with ECG abnormalities among adults with opioid use disorder attending the Itega addiction center for methadone-assisted therapy (MAT). Methodology A cross-sectional analytical study was conducted among adult outpatients attending the Itega addiction center in Dodoma. A calculated sample size of 321was attained through a convenience sampling approach. A standard 12-lead ECG was recorded for each participant and interpreted by two independent cardiologists. Univariate and multivariable logistic regression was computed to determine the factors associated with ECG abnormalities. Under adjusted analysis, a p-value of less than 0.05 was considered significant for factors associated with ECG abnormalities after controlling for all the variables with a minimum p-value of 0.2 at univariate analysis. Results The majority of 308 (95.95%) of the participants were males, 197 (61.37%) had attained primary education level, and the mean age of the participants was 35.44 ± 6.54 years. The overall prevalence for any ECG abnormalities in this study was 26.47%, with Sinus bradycardia 59(18.4%) being the most observed ECG abnormality, followed by QTc prolongation 27(8.41%). A month's increase in the duration on MAT and being a female were significantly associated with lower odds of ECG abnormalities (AOR =0.85, 95% CI =0.74-0.96 p =0.014) and (AOR = 0.05, 95% CI = 0.01-0.59, p = 0.017) respectively. Conclusion The high prevalence of ECG Abnormalities implies high cardiovascular risk among a population with opioid use disorder. Given that majority of the ECG abnormalities are treatable, integrating cardiovascular care in the opioid addiction clinic would be beneficial for this population.

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Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article

Cited by 4 publications

References 105 publications

Substance Use in Pregnancy and its Association With Cardiovascular Events

Substance Use in Pregnancy and its Association With Cardiovascular Events

Possible Delay in Symptomatology of a Methadone Overdose in a Patient Ingesting an Energy Drink and Dextroamphetamine/Amphetamine

Prevalence and factors associated with electrocardiographic abnormalities among adults attending Methadone Assisted Therapy in Dodoma, central Tanzania

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