Date: 18 Apr 2007

Methadone-induced Torsade de pointes after stopping lopinavir–ritonavir

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Various drugs can cause prolongation of the QT interval in an ECG, and in rare cases this is followed by the development of potentially fatal Torsade de pointes (TdP) [1]. Since 2001, reports to the drug authorities in Europe and the USA have raised concerns that methadone may prolong the QT interval and thereby cause fatal arrhythmias. QT prolongation induced by methadone is dose-dependent. Patients treated for opioid dependence with methadone often receive concomitant medications for psychiatric disorders and infections (e.g. HIV), which allows great potential for drug–drug interactions. Described here is a case in which interruption of antiretroviral treatment triggered TdP by elevating the level of methadone in the patient’s blood.

A 53-year-old HIV-positive female patient presented in December 2005 with a 2-month history of weakness, weight loss (8 kg) and fatigue. She had contracted HIV in 1992. Since July 2004 she had been on a combination antiretroviral therapy (cART) consisting ...