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22 May 2014 Baseline electrocardiogram (ECG): Obtain an ECG before initiating methadone therapy in patients with risk factors for prolonged corrected QT interval (QTc), any prior ECG demonstrating a QTc greater than 450 ms, or a history suggestive of prior ventricular arrhythmia. Consider obtaining an ECG before
Drug-induced long QT syndrome occurs with a wide range of medications, including methadone. Prolongation of the QT interval serves as a surrogate marker for the risk of developing Torsades de Pointes (TdP), a relatively rare and potentially lethal ventricular arrhythmia.

Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval
27 Jan 2009 New safety recommendations have been issued regarding arrhythmia risk and QTc interval monitoring for clinicians prescribing methadone.
17 Mar 2009 The paucity of long-term studies of QTc interval–prolonging drugs in large populations makes it difficult to assign a relative risk for arrhythmia, although a QTc interval greater than 500 ms was associated with a 4-fold increase in syncope or sudden death, presumably from torsade de pointes, in patients with
Ann Intern Med. 2009 Mar 17;150(6):387-95. Epub 2009 Jan 19. QTc interval screening in methadone treatment. Krantz MJ(1), Martin J, Stimmel B, Mehta D, Haigney MC. Author information: (1)Colorado Prevention Center, 789 Sherman Street, Suite 200, Denver, CO 80203, USA. Comment in Ann Intern Med. 2009 Aug 4
Q-T interval prolongation can also lead to the potentially fatal reentrant arrhythmia known as torsades de pointes (TdP). However, the mere presence of Q-T interval prolongation may not lead to TdP. Methadone is a synthetic opioid associated with prolonged Q-T intervals and TdP.
19 Jul 2013 Screening guidelines recommended several years ago by an Expert Panel (Krantz, 2009) were a pretreatment ECG for all patients being considered for methadone treatment, to measure the QTc interval; a follow-up ECG within 30 days and annually; and additional ECGs if the daily methadone dosage
Many studies have reported on QTc interval prolongation caused by methadone. In one literature analysis, patients prolonged QTc intervals varied from 9% to 88%.1 ECG readings showed QTc intervals of 413-457 msec with a change from . Consensus guideline on parenteral methadone use in pain and palliative care.

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March 2018