Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Methadone Maintenance and QT-interval: Prevalence and Risk Factors. Is it Effective to Switch Therapy to Levomethadone?

Laura Santin
* ,
Giuseppe Verlato
ORCID logo ,
Ahmad Tfaily
,
Roberto Manera
,
Giuseppe Zinfollino
,
Francesca Fusina
,
Lugoboni Fabio
Version 1 : Received: 1 June 2023 / Approved: 2 June 2023 / Online: 2 June 2023 (12:24:02 CEST)

A peer-reviewed article of this Preprint also exists.

Santin, L.; Verlato, G.; Tfaily, A.; Manera, R.; Zinfollino, G.; Fusina, F.; Lugoboni, F. Methadone Maintenance and QT-Interval: Prevalence and Risk Factors—Is It Effective to Switch Therapy to Levomethadone? Biomedicines 2023, 11, 2109. Santin, L.; Verlato, G.; Tfaily, A.; Manera, R.; Zinfollino, G.; Fusina, F.; Lugoboni, F. Methadone Maintenance and QT-Interval: Prevalence and Risk Factors—Is It Effective to Switch Therapy to Levomethadone? Biomedicines 2023, 11, 2109.

Abstract

(1) Methadone is a chiral synthetic opioid primarily used to treat heroin and prescription-opioid addiction: the (R)-enantiomer (Levomethadone) activates the µ-opioid receptor more potently than the (S)-enantiomer, which is a more potent blocker of the hERG potassium channels, resulting in QTc prolongation. The purpose of this study is to assess the effect of methadone on the QTc interval and to investigate the benefits of Levomethadone. (2) The electrocardiograms of 165 patients taking methadone at various dosages and for different periods of time were examined: the QTc value was manually measured and then adjusted using Bazett's formula. (3) Data analysis revealed a linear association between the dosage of methadone and QTc length; no correlation was found between the QTc value and gender, age, or duration of therapy. 14% of the sample (23 patients) showed a prolongation of the QTc interval. 10 of the 23 patients with QTc elongation underwent a change of therapy from Methadone to Levomethadone: in 90% of these patients, a normalization in the QTc length was established. (4) This study confirmed the role of methadone, specifically its dosage, in QTc prolongation and the efficiency of Levomethadone as an adequate therapeutic substitute in these circumstances. This study validates the importance of a careful electrocardiographic monitoring in methadone-treated patients.

Keywords

Methadone; levomethadone; QTc; prolongation; treatment; heroin; therapy-switch

Subject

Medicine and Pharmacology, Internal Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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