PMID- 28186837
OWN - NLM
STAT- MEDLINE
DCOM- 20180430
LR  - 20190206
IS  - 1557-7740 (Electronic)
IS  - 1557-7740 (Linking)
VI  - 20
IP  - 7
DP  - 2017 Jul
TI  - Methadone and Corrected QT Prolongation in Pain and Palliative Care Patients: A 
      Case-Control Study.
PG  - 722-728
LID - 10.1089/jpm.2016.0411 [doi]
AB  - BACKGROUND: Methadone (ME) is commonly used in pain and palliative care (PPC) 
      patients with refractory pain or intolerable opioid adverse effects (AEs). A 
      unique ME AE is its corrected QT (QTc) interval prolongation risk, but most 
      evidence exists in methadone maintenance therapy patients. OBJECTIVE: Our goal 
      was to identify QTc interval prolongation risk factors in PPC patients receiving 
      ME and other medications known to prolong the QTc interval and develop a risk 
      stratification tool. DESIGN: We performed a case-control study of adult 
      inpatients receiving ME for pain management. Settings/Subjects: Adult inpatients 
      receiving ME with a QTc >470 msec (males) and >480 msec (females) were matched 
      1:2 according to age, history of QTc prolongation, and gender with ME patients 
      who did not have a prolonged QTc interval. QTc prolongation risk factors were 
      collected for both groups. Covariates were analyzed using conditional logistic 
      regression. Classification and regression tree analysis was used to identify the 
      ME dose associated with QTc prolongation. RESULTS: Predictors of QTc prolongation 
      included congestive heart failure (CHF) (OR: 11.9; 95% CI: 3.7-38.2; p < 0.00), 
      peptic ulcer disease (PUD) (odds ratio [OR]: 8.3; 95% confidence interval [95% 
      CI]: 2.4-28.9; p < 0.00), hypokalemia (OR: 6.5; 95% CI: 1.5-28.2; p < 0.01), 
      rheumatologic diseases (OR: 4.7; 95% CI: 1.6-13.9; p < 0.00), taking medications 
      with a known torsades de pointes (TdP) risk (OR: 4.4; 95% CI: 1.8-10.7; 
      p < 0.01), malignancy (OR: 3.3; 95% CI: 1.2-9.3; p < 0.03), hypocalcemia (OR: 
      2.1; 95% CI: 0.9-4.8; p < 0.07), and ME doses >45 mg per day (OR: 1.9; 95% CI: 
      0.8-4.8; p < 0.16). Mild liver disease was protective against QTc prolongation 
      (OR: 0.05; 95% CI: 0.0-0.46; p < 0.01). CONCLUSIONS: Predictors of QTc 
      prolongation in our multivariate conditional logistic regression model included 
      CHF, PUD, hypokalemia, rheumatologic disorders, use of medications with a known 
      TdP risk, malignancy, hypocalcemia, and ME doses >45 mg per day.
FAU - Juba, Katherine M
AU  - Juba KM
AD  - 1 Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher 
      College , Rochester, New York.
FAU - Khadem, Tina M
AU  - Khadem TM
AD  - 2 Department of Pharmacy, University of Rochester Medical Center-Strong Memorial 
      Hospital , Rochester, New York.
FAU - Hutchinson, David J
AU  - Hutchinson DJ
AD  - 1 Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher 
      College , Rochester, New York.
FAU - Brown, Jack E
AU  - Brown JE
AD  - 1 Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher 
      College , Rochester, New York.
LA  - eng
PT  - Journal Article
DEP - 20170210
PL  - United States
TA  - J Palliat Med
JT  - Journal of palliative medicine
JID - 9808462
RN  - 0 (Analgesics, Opioid)
RN  - UC6VBE7V1Z (Methadone)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics, Opioid/*adverse effects/*therapeutic use
MH  - Cancer Pain/*drug therapy
MH  - Case-Control Studies
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Long QT Syndrome/*chemically induced
MH  - Male
MH  - Methadone/*therapeutic use
MH  - Middle Aged
MH  - Neoplasms/*complications
MH  - *Opiate Substitution Treatment
MH  - Palliative Care/methods
MH  - Risk Factors
OTO - NOTNLM
OT  - QTc prolongation
OT  - methadone
OT  - pain
OT  - palliative care
OT  - risk factors
EDAT- 2017/02/12 06:00
MHDA- 2018/05/01 06:00
CRDT- 2017/02/11 06:00
PHST- 2017/02/12 06:00 [pubmed]
PHST- 2018/05/01 06:00 [medline]
PHST- 2017/02/11 06:00 [entrez]
AID - 10.1089/jpm.2016.0411 [doi]
PST - ppublish
SO  - J Palliat Med. 2017 Jul;20(7):722-728. doi: 10.1089/jpm.2016.0411. Epub 2017 Feb 
      10.