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Chronic Pain Whatever the cause, support for managing long term or intractable pain. |
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09-28-2006, 11:50 AM | #4 | |||
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Wisest Elder Ever
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I had this information up on the chronic pain board, at OBT.
So I am moving it here as well. In the news just this week is the tragic death of Anna Nicole Smith's 20yr old son. 2 days ago I saw the Cyril Wecht who was hired by Ms Smith to do the autopsy reported on Court TV that the death is being called a Torsade de Pointes or in English a Prolongation of QT and sudden cardiac death. Daniel Smith had Zoloft, Lexapro (why both is confusing) and METHADONE in his tox screen results. Methadone is the only opiate to cause this interaction and effect on the heart. So patients who are using this opiate for pain management need to be aware that 1) they should be evaluated for prolongation of QT with an EKG before treatment is started, and 2) use of drugs that appear on the lists for causing this could be additive with methadone. Some new papers have surfaced in the medical community warning physicians to screen their patients for cardiac risk. http://jama.ama-assn.org/cgi/content/extract/290/8/1025 But not all doctors read the newest findings. So I am putting them here for readers on this board. Quote:
Quote:
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It is difficult to find illustrations of the electrocardiogram that illustrate the QT tracing. I used to have a good link here, but it closed. Most people watch TV and see doctor shows, which show this tracing on the monitors. All of the separate parts of the graph have labels, from Q, R, S, T, and the timing for this can be measured. When the timing gets prolonged, the heart cannot maintain its built in rhythm and the ventricles begin to beat independently, and may go into a fib condition (trembling) and the heart must be reset with a shock, using the paddles. The University of Arizona keeps a good up to date list on four categories of drugs involving QT issues. Here is their new website: http://www.azcert.org/ The 4 lists of drugs are on PDF files and don't have links. Anyone on Methadone should print out what I have posted here and take to their doctor, if cardiac concerns have not been discussed. Not all doctors understand the new methadone data or have read it. There is still a general assumption that all opiates are not QT risks. And that is no longer true. Adding a link here: http://www.ptcommunity.com/ptjournal...PTJ3103159.pdf This link discusses the common use of proton pump inhibitors (Prilosec, Nexium, Aciphex, Prevacid, Protonix) and how these drugs affect other medications and absorption. Listed is methadone, which is enhanced by these drugs. So people on methadone for pain could have dosage problems if taking a PPI at the same time. Be careful adding a link re FDA warning on Haldol and QT http://www.fda.gov/cder/drug/InfoShe...aloperidol.htm This link is to a site that explains the genetics of drug metabolism. People who are "slow metabolizers" are at greater risk for drug interactions or negative responses to certain drugs: http://www.dnadirect.com/web/article...s/186/ancestry and http://www.dnadirect.com/web/article...574439B11AEAF2
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All truths are easy to understand once they are discovered; the point is to discover them.-- Galileo Galilei ************************************ . Weezie looking at petunias 8.25.2017 **************************** These forums are for mutual support and information sharing only. The forums are not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. Always consult your doctor before trying anything you read here.
Last edited by mrsD; 05-21-2009 at 04:51 AM. Reason: fixing old links |
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