This is a great thread, good questions and answers from all. I find it particularly helpful as I was recently told by a pain physician (outside of the Ketamine coma) that methadone is most likely the only alternative I may have if my Lidocaine stops working. With the nature of RSD being what it is I suspect that will will happen some day.

Thanks to all for your honest contributions.

MsL

I was suggested methadone a few months ago but it was ruled out because of my other heath conditions and the cardiac concern like Mrs D stated. If so he wanted to do and I am not sure if it was all together or in steps but ketamine infusions,methadone,and possible scs temp. I know a girl who was on methadone too and found it helpful with her pain and this was after she had the scs.

Hi Pete,

The QT is the letter designation of the heart tracing on paper.
You know the jagged lines etc?

Some drugs, some genetic errors, prolong the heart beat, slow the progression from beginning to end. When this slows beyond a certain point, the heart stops. You have possibly seen this during athletic stories or at events. All of a sudden, a seemingly normal person konks out. This is why now airplanes have defib paddles, gyms, some public places now.
Doctors measure this distance on the tracing according to time...nanoseconds sometimes to see if people are prone to this. Another name for this is Torsades de Points.

Drugs cause this. Anna Nichol Smith's son Daniel died of a non lethal amount of methadone mixed with the SSRI antidepressant Lexapro, right in her hospital room. This was all over the media.

The effects of methadone as an opiate are unique among them all. It also has a very long half life, and the pain relieving effects wear off BEFORE the drug leaves the body safely so with time if dosed wrong can build up in a serious way.

The original data on this came from Europe, from clinics providing Heroin treatment. One study I read a couple of years ago found their patients dying all of a sudden...and it was due to mixing cocaine with the methadone (outside the clinic). They started doing EKGs and found this QT effects and published.

Methadone has been around for a long time...My FIL took it as Dolophine when he had throat cancer in the late 60's. It and Dilaudid were the most often used back then.
QT effects have become more prominent lately. The old RX Seldane was on the market for over a decade and just about to be released OTC, when a doctor at Georgetown Univ discovered it was killing people when used with the antibiotic erythromycin!
No one had a clue, not the drug companies...no one until then.
They just thought people had an arrhythmia and died. They never connected it to Seldane. Now Seldane has been taken off the market in US, but some countries allow it still.
There are many drugs now, that have been discovered to affect the heart this way. The link I gave has 4 lists according to risk types.

I have a post on Chronic Pain here:
Post #4
http://neurotalk.psychcentral.com/thread1120.html
has some of the studies on it..
Some of the links may not work, the post is old and the net changes. The geniassance link with diagrams appears to be gone. It was really nice!
This is wiki entry:
http://en.wikipedia.org/wiki/Torsades_de_pointes

Its difficult to find the graphs I used to use... they don't seem common on the net.

I hope this answers your question. Long QT (aka Torsades de Pointes) is a sudden event. With all the newer drugs we have it is more common than before.

I hope I've answered your question..I am not a great writer. If you have other concerns you can PM me anytime.

mrsd
this is great info as i have found out in the last 2 years that my tackicardia wasnt just plain old tackicardia. that in fact that i have ventricular tackycardia and certain will cause my normal high HR to exceed 200 BPM
just like with long QT i cant take alburterol or things like it because it raises my heart rate.
carrie

MRS. D

Thanks so very much!
That's excellent information that everyone / anyone using or considering the use of Methadone should know.

My doctor did give me a short "lecture" about it recently, to be sure I was aware of how powerful a drug it is. You are a great writer, and drew a perfect picture!!

Thanks again!

Pete
Asb

erratum
 

In reflecting further upon the safety issues of Methadone, I realize that I could have been more thoughtful in the initial post at the top of the thread, when I referred to the "Prescribing Information" sheet, to which I then linked.

In retrospect, and as with Opana ER http://www.opana.com/pdf/opana_er_pi.pdf#page=16, I should have referred to fact that Methadone has a "black box" Prescribing Information sheet, so that the reader might be aware that there were potentially significant safety issues associated with the drug, including the possibility of death.

Apologies.

on the q.t.
 

My pharmacist reads to me from his text, that QT issues involving Methadone are "generally associated with higher doses," which in turn are defined as "> 200 mg/day."

Vel non Torsades de Points, I wouldn't want to know how 200 mg./day of Methadone even felt!

Please give your pharmacist the University of Arizona website.
Combination factors will potentially affect response to methadone.

200mg is really a high dose. Very few people get to that place.

Here is another link:
http://www.cdc.gov/nchs/products/pub.../poisoning.htm
This reflects the increased use of methadone to treat chronic pain.
I don't have figures past 2005 at this time.

I believe the increased use (as I've read) of methadone for chronic pain, is due to ins. co. pressure. It's very inexpensive.
This doesn't mean that methadone isn't as safe as more modern meds (imho) such as oxycontin, or opana. It simply means that there's more methadone out there, as time goes on.

It's potential for abuse, again, imho, is lower as well.

Again, this is my opinion.
"Talk to your doctor".

Methadone has a quirk in metabolism. The pain receptor effects wear off before the drug is cleared from the body.

So dosing may be ordered too frequently and hence the other potentially dangerous effects become more likely.

http://findarticles.com/p/articles/m.../ai_n29445367/
In practice this is what I see... Doctors do not understand the liver enzyme systems and often do not refer to charts which list which drugs affect which subsystem of the P-450 complex in the liver. Add to that that genetically there are people with errors in this system, which make them "slow metabolizers". For example when the statin drug for cholesterol ..the very potent Crestor... went on the market no one expected that slow metabolizers would not be able to handle standard doses of it.
So some people died, or were damaged.

For those here who are interested in the Medwatch reports on drugs...this website gives them:
http://www.patientsville.com/

Here are the reports on Methadone:
http://patientsville.com/medication/...de_effects.htm
Keep in mind some reports are complex and involve multiple disease states, and/or complex drug cocktails. But many are very representative of the drug cited. Most drug reactions are not reported, and it is believed around 1% up to maybe 10% are. So keep that in mind also. Doctors balk at reporting, thinking admission of error may lead to liability suits.

This chart shows the ethnicity of drug metabolism differences:
http://www.dnadirect.com/web/article...s/186/ancestry

This chart gives the subcategories of the P-450 system and the drugs affected in each:
http://www.dnadirect.com/web/article...574439B11AEAF2
We are approaching a time now in medicine where genetics of EACH patient makes a huge difference in therapeutic response, or risk from side effects or worse.
I foresee a computer eventually being used and testing of each person before prescribing drugs. Many doctors are confused by these charts and never test their patients to see if they are slow metabolizers. The tests remain expensive at this time and some insurances won't pay for them. So that hit or miss prescribing is still the norm.

Here is a link to methadone and drug interactions for it:
http://www.atforum.com/pdf/Drug_Interactions.pdf
It is complex however. But some posters here may want it, or want
to print it out, for reference.