Anaes Vivas · Anaesthetic adjuncts
Methadone pharmacology and safety
Viva interpreting a methadone accumulation pharmacokinetic graph and a QT-prolongation ECG.
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Prompt
A graph of plasma methadone concentration over time on a fixed 8-hourly dosing regimen, showing accumulation towards a toxic level; and a 12-lead ECG showing QT prolongation.
Stimulus
You are shown a graph of plasma methadone concentration over successive days on a fixed 8-hourly oral dosing regimen, demonstrating progressive accumulation towards a toxic threshold; alongside it, a 12-lead ECG showing a markedly prolonged QT interval. Interpret the data and discuss the pharmacology and safety implications (review-scope; systematic-review hERG) [2][4].
References4ShowHide
- [1]Ganthan RR, et al. Polymorphic Ventricular Tachycardia and Torsades in Methadone Therapy Captured by Loop Recorder. JACC Case Rep, 2026.PMID 42313032
- [2]Kreutzwiser D, Tawfic QA Methadone for Pain Management: A Pharmacotherapeutic Review. CNS Drugs, 2020.PMID 32564328
- [4]El Sherbini A, Liblik K, Lee J, et al. Opioids-induced inhibition of HERG ion channels and sudden cardiac death, a systematic review of current literature. Trends Cardiovasc Med, 2024.PMID 37015297
- [6]Chen J, et al. Top Ten Tips Palliative Care Clinicians Should Know About Navigating Outpatient Opioid Prescribing. J Palliat Med, 2026.PMID 42363735