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Methadone and prolongation of QT interval

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • there is a risk of QT interval prolongation in patients taking methadone, especially those on high doses (1)
    • there is evidence that very-high-dose methadone may be associated with torsade de pointes (2)
  • recommended that patients with the following risk factors for QT interval prolongation are carefully monitored whilst taking methadone:
    • heart or liver disease, electrolyte abnormalities, concomitant treatment with CYP 3A4 inhibitors, or medicines with the potential to cause QT interval prolongation (1)
      • also any patient requiring more than 100mg of methadone per day should be closely monitored (1)
      • the RCGP guidance also notes that the risk of QT-interval prolongation may be dose-dependent (3)
        • "..methadone may be a risk factor for QT prolongation and torsade de pointes with a possible dose-dependent action... recommends monitoring for patients on high dose methadone (>100 mg daily) and with other QT interval prolongation risk factors where appropriate.."

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