Methadone case histories

The following case history includes several features which are reasonably characteristic of progress in treatment with methadone, as delivered in a community setting. 

Propoxyphene (dextropropoxyphene Darvon) is structurally related to methadone but is much less potent as an analgesic. Compared with codeine, propoxyphene is approximately half as potent and is indicated for the treatment of mild pain. It is not antipyretic or antiinflammatory like aspirin and is less useful than aspirin in most cases of mild pain. Toxicity from propoxyphene, especially in combination with other sedatives, such as alcohol, has led to a decrease in its use. Death following ingestion of alcohol in combination with propoxyphene can occur rapidly (within 20 minutes to 1 hour). The drug is not indicated for those with histories of suicide or depressive illnesses. 

The association between methadone treatment and QTC interval prolongation, QRS widening, and bradycardia has been explored prospectively in 160 patients with at least a 1-year history of opioid misuse (19). The QTC interval increased significantly from baseline at 6 months (n = 149) and 12 months (n = 108). The QRS duration and heart rate did not change. There were no cases of torsade de pointes, cardiac dysrhythmias, syncope, or sudden death. There was a positive correlation between methadone concentration and the QTC interval. 

A case of neuroleptic malignant syndrome is reported in a 36-year-old male receiving methadone, venlafaxine and quetiapine IR (50 mg daily) with history of hepatitis C and hypothyroidism [215 ]. Another case of neuroleptic malignant syndrome in a 48-year-old female occurring 1 montix after initiating quetiapine XR is reported [216 ]. 

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