The frequency of QTc prolongation among pediatric and young adult patients receiving methadone for cancer pain

Madden, Kevin; Park, Minjeong; Liu, Diane; Bruera, Éduardo

doi:10.1002/pbc.26614

Cited by 26 publications

(11 citation statements)

References 26 publications

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“…Given methadone's long and unpredictable halflife, 17e19 this seems to be prudent and is congruent with recommendations by the American Pain Society (APS). 14 Although uncommon, 5 methadone may directly increase the QTc interval and lead to torsades de pointes (TdP), a potentially fatal arrhythmia. 20 Adult data show that the risk of TdP with respect to the QTc interval is linear, becoming exponential when the QTc $ 500 milliseconds.…”

Section: Discussionmentioning

confidence: 99%

Attitudes, Beliefs, and Practices of Pediatric Palliative Care Physicians Regarding the Use of Methadone in Children With Advanced Cancer

Madden

Liu

Bruera

2019

Journal of Pain and Symptom Management

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Context. Methadone is a long-acting opioid known for its unique pharmacokinetic and pharmacodynamic properties. Most research on methadone in children is limited to its effect on the prolongation of the corrected QT (QTc) interval. Objectives. To better understand the attitudes, beliefs, and practices of pediatric palliative care physicians regarding the use of methadone in children with advanced cancer. Methods. A survey was sent to the American Academy of Pediatrics Section of Hospice and Palliative Medicine LISTSERV. Information on demographics, dosing of methadone, and the use of electrocardiograms (ECGs) was collected. Results. One-hundred and five respondents (91%) provide palliative care to children $ 50% of the time, and a majority (81, 77%) prescribe methadone. Most (62, 77%) physicians were board certified in Hospice and Palliative Medicine, and most (39, 63%) certified via the direct pathway (''grandfathering''). Most physicians (57, 70%) do not use loading doses of methadone. Board-certified physicians trended toward decreasing methadone dose more (40% AE 19%) than noneboardcertified physicians (28%, AE20%) when changing from the oral to intravenous route (P ¼ 0.07). Respondents defined a QTc interval as ''prolonged'' (mean AE SD) at 444 milliseconds (AE68 milliseconds). The percentage of patients receiving a baseline ECG was 65% (AE33%). The most common reason for not performing a baseline ECG was that the patient was on hospice (13, 36%). Conclusions. There are consistent practices, attitudes, and beliefs of pediatric palliative care providers with regard to methadone. More education is needed on the accurate value of a prolonged QTc interval.

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Section: Discussionmentioning

confidence: 99%

Attitudes, Beliefs, and Practices of Pediatric Palliative Care Physicians Regarding the Use of Methadone in Children With Advanced Cancer

Madden

Liu

Bruera

2019

Journal of Pain and Symptom Management

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“…These findings demonstrate that lethal arrhythmias could occur within a wide dose range. In contrast, one study indicated that significant QT prolongation was infrequent in pediatric patients with cancer [11]. The safety of prescribing methadone to cancer patients remains unclear.…”

Section: Methadone On Qt Intervalmentioning

confidence: 99%

Effect of Methadone on Cardiac Repolarization in Japanese Cancer Patients: A Longitudinal Study

Yamanaka¹,

Chino²,

Takasusuki³

et al. 2019

Cardiol Ther

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Introduction: Methadone is known to prolong the QT interval, which could induce lethal arrhythmias such as torsades de pointes. To determine the risk of ventricular arrhythmias in cancer patients using methadone, we measured QT dispersion (QTD) and Tpeak-Tend (TpTe) before and after methadone administration and evaluated the correlations between methadone dosage and cardiac repolarization. Methods: We conducted a retrospective observational study with 19 patients undergoing follow-up for cancer pain with methadone. Electrocardiogram (ECG) recordings were obtained from the patients at methadone initiation and 1 week, 1 month, and 2 months later. The QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), TpTe, TpTe/QT, and TpTe/QTc were measured manually via ECG records and analyzed using a repeated measures one-way ANOVA. The correlations between these ECG parameters and each methadone dosage were determined using Spearman's rank correlation coefficient. Results: The QTD, QTcD, TpTe/QT, and TpTe/ QTc remained unchanged, while TpTe was prolonged significantly at 2 months (initiation: 82 ± 17 ms; 2 months: 106 ± 20 ms, p = 0.018). In addition, there was a positive correlation between TpTe and methadone dosage (rs = 0.4, p = 0.041). Conclusions: The findings suggested that small or modest doses of methadone could exert dosedependent effects on cardiac repolarization in cancer patients.

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“…Methadone is a very useful long acting mu -agonist and NMDA antagonist [68] agent available in a variety of forms for easy pediatric dosing. Consultation with a provider comfortable with dosing and management may be necessary [69,70]. Fentanyl patches provide transdermally delivered opioid that can be used in opioid tolerant patients; however, doses are fixed and therefore can be difficult to titrate in smaller patients.…”

Section: Painmentioning

confidence: 99%

Palliative Care for Children with Central Nervous System Malignancies

Baenziger

Moody

2018

Bioengineering

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Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary pediatric palliative care.

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The frequency of QTc prolongation among pediatric and young adult patients receiving methadone for cancer pain

Cited by 26 publications

References 26 publications

Attitudes, Beliefs, and Practices of Pediatric Palliative Care Physicians Regarding the Use of Methadone in Children With Advanced Cancer

Attitudes, Beliefs, and Practices of Pediatric Palliative Care Physicians Regarding the Use of Methadone in Children With Advanced Cancer

Effect of Methadone on Cardiac Repolarization in Japanese Cancer Patients: A Longitudinal Study

Palliative Care for Children with Central Nervous System Malignancies

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