Methadone and Torsades de Pointes: A Case Series

This case series reports on three patients undergoing methadone treatment for opioid use disorder (OUD) who developed significant QT prolongation and Torsades de Pointes (TdP). We compare patient-specific risk factors contributing to QT prolongation, including methadone dose. During their hospitalization and outpatient care, we review the use of various management strategies, including methadone dose reduction, transition to buprenorphine, and cardiac therapies such as antiarrhythmics and implantable cardioverter-defibrillators (ICDs) to reduce cardiac risk. Lastly, we examine post-hospitalization outcomes and follow-up. By reporting these cases, we aim to highlight treatment strategies that balance the risk of dysrhythmia with the risk of destabilizing OUD treatment. Patient consent was obtained for the development of the case series.