Which of the following drugs has been given a U.S. Food and Drug Administration (FDA) black box warning regarding an increased risk of death?
Methadone use for the treatment of chronic pain as well as opioid dependence is increasing. The FDA issued a physician safety alert regarding increasing deaths and cardiac dysrhythmias in patients treated with methadone; this was followed by a manufacturer’s black box warning. The increased hazard of using methadone arises from two distinct properties that may make it a particularly dangerous opioid: 1) it prolongs the rate-corrected QT interval (QTc); and 2) it has profound interindividual pharmacokinetic variability.
The potential to increase the QTc has led some experts to recommend routine baseline and surveillance electrocardiograms (ECGs) for patients treated with methadone, similar to the recommendations for droperidol. Physicians should become knowledgeable about the risk of prescribing other drugs that may also prolong the QTc or alternatively diminish...
