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Methadone for pain and the risk of adverse cardiac outcomes
Lea C Price1, Brooke Wobeter2, Thomas Delate3
1Kaiser Permanente-Colorado, Denver, Colorado, USA; University of Colorado Skaggs School of Pharmacy, Denver, Colorado, USA; Regis University Rueckert-Hartman College for Health Professions, School of Pharmacy, Denver, Colorado, USA.
Insights
Methadone for pain management rarely caused cardiac events, but many patients were at risk. Older patients and those on higher methadone doses faced increased cardiac risks.
Area of Science:
- Cardiology
- Pain Management
- Pharmacovigilance
Background:
- Limited research exists on cardiac adverse events in patients using methadone for pain.
- Methadone is frequently prescribed for pain, necessitating an understanding of its cardiac safety profile.
Purpose of the Study:
- To identify incident cardiac adverse events in primary care patients prescribed methadone for pain.
- To determine risk factors associated with cardiac adverse events in this patient population.
Main Methods:
- Retrospective, descriptive cohort study of patients aged 18+ receiving methadone for pain in 2010.
- 12-month follow-up to assess primary outcomes: cardiac event, at risk for event, or neither.
- Comparison of risk factors and methadone monitoring between chronic and non-chronic methadone users.
Main Results:
- Out of 1246 patients, 2.4% experienced a cardiac event, 50.4% were at risk, and 47.2% had neither.
- QTc prolongation occurred in 49.4% of patients; adherence to cardiac monitoring was 39.0%.
- Independent risk factors for cardiac events included older age (OR=1.06) and methadone dose ≥ 100 mg/day (OR=6.18).
Conclusions:
- While direct cardiac events were infrequent, a significant proportion of patients were identified as being at risk.
- Older patients and those on higher methadone doses (≥ 100 mg/day) exhibited a higher risk for adverse cardiac events.
- The findings highlight the need for vigilant cardiac monitoring in specific patient subgroups receiving methadone for pain management.
Context:
There are few studies that describe cardiac adverse events in patients prescribed methadone for pain management.
Objectives:
To describe incident cardiac adverse events and risk factors for cardiac adverse events in primary care patients prescribed methadone for pain.
Methods:
This was a retrospective, descriptive, cohort study in patients 18 years or older receiving methadone for pain management during 2010. Patients were followed for 12 months and were categorized as "chronic" or "non-chronic" methadone users. The primary outcomes were a cardiac event, at risk for an event, or neither. Patients were grouped on their outcome and were compared on risk factors and methadone monitoring.
Results:
A total of 1246 patients were included. Thirty (2.4%), 628 (50.4%), and 588 (47.2%) patients had a cardiac event, were at risk for an event, or had neither an event nor a risk factor, respectively. Overall, the rate of QTc prolongation was 49.4% and the rate of adherence to recommended cardiac monitoring was 39.0%. Similar percentages of chronic and non-chronic users had a cardiac event (P > 0.05). Among the patients who had a cardiac event and were at risk for an event, factors independently associated with having had an event included age (odds ratio = 1.06; 95% CI = 1.03-1.09) and a dose 100 mg/day or higher (odds ratio = 6.18; 95% CI = 1.08-35.45).
Conclusion:
Few cardiac adverse events resulting from methadone use for pain were detected. However, a large proportion of patients were at risk for an adverse event, especially patients who were older and had received ≥ 100 mg/day of methadone.
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