Methadone: To ECG or Not to ECG…That Is Still the Question

There is significant controversy about the potential deleterious effect of methadone on cardiac conduction. Although several reports suggest that patients receiving methadone are at increased risk for QTc prolongation and torsade de pointes, a potentially fatal arrhythmia, others have not replicated these findings. Hence, it is not surprising that there is no consensus on when to perform an electrocardiogram, a simple test to assess the QTc interval, during methadone therapy. Most of the uncertainty is generated by the lack of large controlled studies. This review presents the current data on this issue in an effort to help in the decision-making process until more conclusive data become available.