Rapid Transition to Buprenorphine in a Patient With Methadone-Related QTc Interval Prolongation.
| Autor: | Brogdon H; From the Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, WA, USA (HB, RHC, JFW); University of Washington School of Medicine, Seattle, WA, USA (KLF); Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA (KLF); Providence Medical Research Center, Providence Health Care, Spokane, WA, USA (EJC)., Facer KL, Cox EJ, Carlson RH Jr, Wurzel JF 3rd |
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| Jazyk: | angličtina |
| Zdroj: | Journal of addiction medicine [J Addict Med] 2022 Jul-Aug 01; Vol. 16 (4), pp. 488-491. Date of Electronic Publication: 2021 Dec 03. |
| DOI: | 10.1097/ADM.0000000000000935 |
| Abstrakt: | Background: Patients with opioid use disorder (OUD) who are managed on methadone often require transition to buprenorphine therapy. Current recommendations require months to gradually taper off of methadone; however, in some cases, the need to transition is urgent. Only a few rapid methadone-to-buprenorphine transitions have been reported and there are no established protocols to guide clinicians in these cases. Case Presentation: A 43-year-old man on 95 mg methadone for opioid use disorder experienced cardiac arrest attributable to ventricular fibrillation caused by QTc interval prolongation from methadone. In the hospital, a gradual taper of methadone was initiated but proved intolerable; the patient requested to restart his home dose of methadone and leave against medical advice. A rapid transition was initiated instead. Naltrexone (25 mg) was used to precipitate acute withdrawal followed 1 hour later by a "rescue" with buprenorphine/naloxone (16 mg/4 mg). The Clinical Opiate Withdrawal Score (COWS) peaked at 21 post-naltrexone and fell quickly to 15 within a half-hour of buprenorphine/naloxone administration. The patient was maintained on a total daily dose of 16 mg/4 mg buprenorphine/naloxone through the time of discharge. Conclusions: A patient requiring an urgent taper off of methadone due to adverse cardiac effects successfully transitioned to buprenorphine/naloxone within 2 hours by using naltrexone to precipitate withdrawal followed by a "rescue" with buprenorphine/naloxone. A relatively high dose of 16 mg/4 mg buprenorphine/naloxone successfully arrested withdrawal symptoms. With further refinement, this protocol may be an important technique for urgent methadone-to-buprenorphine transitions in the inpatient setting. Competing Interests: The authors report no conflicts of interest. (Copyright © 2021 American Society of Addiction Medicine.) |
| Databáze: | MEDLINE |
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