Sustained release oral morphine as an alternative to methadone for the treatment of opioid-use disorder post Torsades de Pointes cardiac arrest

Walton, Geoffrey; Nolan, Seonaid; Sutherland, Cindy; Ahamad, Keith

doi:10.1136/bcr-2015-210239

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…Dose reduction or substitution of methadone is also reasonable. Some alternatives of methadone may also be considered including buprenorphine, naltrexone, or slow releasing morphine [ 11 ]. For patients with ventricular tachyarrhythmia, in addition to cessation of offending agents and electrolyte correction, magnesium sulfate is the first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

Tam

Lam

Mok

et al. 2020

Case Reports in Cardiology

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Methadone is a well-tolerated drug that has been used for pain control and the treatment of opioid addiction. However, some fatal cardiac side effects have been reported previously, including ventricular arrhythmia, stress cardiomyopathy, and coronary artery disease. We reported a middle-aged woman receiving high-dose methadone whom was presented with QT prolongation and torsade de pointes. We replaced the methadone with benzodiazepine and gave lidocaine use simultaneously. Thus, QT interval was shortened within the normal limit. Methadone-induced torsade de pointes is a rare but serious event, and QT interval should be monitored periodically to prevent this fatal adverse event, especially some patients with high-dose methadone use.

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Section: Discussionmentioning

confidence: 99%

Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

Tam

Lam

Mok

et al. 2020

Case Reports in Cardiology

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show abstract

“…There is growing interest in the slow-release oral morphine (SROM), as a potential effective candidate for maintenance treatment [90][91][92]. This medication is given once daily, and it suits those individuals who cannot tolerate methadone, respond poorly to other available treatments, or show a prolonged QT [93][94][95]. However, the last Cochrane meta-analysis reported that there is not enough evidence to confirm the effectiveness of SROM for opioid maintenance, as only three inconclusive studies exist [96].…”

Section: Drugs Acting On Opioid Receptorsmentioning

confidence: 99%

Present and Future Pharmacological Treatments for Opioid Addiction

Blanco-Gandía¹,

Montagud‐Romero²,

Rodrı́guez-Arias³

2020

Opioids - From Analgesic Use to Addiction

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When treating opioid addiction, multidisciplinary treatment is highly recommended, but pharmacotherapy plays a key role. Although the ideal goal is to achieve complete abstinence, an elevated percentage of opioid addicts requires maintenance substitution therapy. In the first section of this chapter, we will focus on the current pharmacological interventions to treat opioid addiction, such as methadone, buprenorphine, and naltrexone. Thanks to these medications, people are able to go back to their normal lives, by preventing withdrawal symptoms, reducing craving, and increasing their adherence to psychotherapy. In the second section, based on the evidence that addiction induces neuroadaptive changes in several neurotransmission systems, we focus on the wide range of possible pharmacological developments at the preclinical and clinical levels, which in recent years have increased considerably.

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“… 7 Morphine has been considered low risk from the perspective of QT interval prolongation 15 and has been suggested for treating opioid addicts who have a prolonged QT interval. 24 However, opium is a mixture of several substances with different effects that may ensue the different clinical manifestations. 9 Yet, there is no evidence that opium consumption is associated with the higher prevalence of prolonged QT interval compared to non-user general population.…”

Section: Introductionmentioning

confidence: 99%

Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study

Javadi¹,

Mirakbari²,

Allami³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Background Toxicity and side effects of long-term use of opioids are well studied, but little information exists regarding electrophysiological disturbances of opium consumption. While natural opium has been regarded safe to a great extent among traditional communities, concerns are emerging owing to the available evidence of QT prolongation that have been exposed during recent outcome surveillance of patients under opioid use. Potential QT prolonging interactions would raise a higher level of such concern in opium users during COVID pandemic and warrant attention. Materials and methods This study was designed to detect the prevalence of QTc prolongation among opium users and nonusers. Two groups were compared with regard to gender, age, and median QTc interval. Normal and prolonged QTc intervals of user group were compared with respect to age, sex, dose of opium consumption, and duration of opium consumption. Results 123 opium users and 39 controls were investigated. Median QTc interval in opium user and non-user group was 460 vs 386 milliseconds, respectively ( p value < 0.001). In all, 59.3%, (95% CI: 50.51–67.62%) of cases and none of non-user had prolonged QTc interval ( p value < 0.001). There was no significance between normal and prolonged QTc intervals with respect to dose and duration of opium use. Conclusion This study indicated that opium consumption is associated with QTc prolongation. This prolongation does not relate to dose and duration of opium use. Further study is propounded to assess the clinical significance of these results and to determine risk rating of opium compared to other opioids in this regard. How to cite this article Javadi HR, Mirakbari SM, Allami A, Yazdi Z, Katebi K. Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study. Indian J Crit Care Med 2021;25(1):43–47.

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Sustained release oral morphine as an alternative to methadone for the treatment of opioid-use disorder post Torsades de Pointes cardiac arrest

Cited by 7 publications

References 40 publications

Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

Present and Future Pharmacological Treatments for Opioid Addiction

Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study

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