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Letters   |    
Torsade de Pointes Associated With Laxative Abuse in a Patient Receiving Methadone
Xavier Laqueille, M.D.; Christophe Genin, M.D.; Benjamin Pitrat, M.D.; Aline Lupuyau, M.D.; Alain Dervaux, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E24-E24. doi:10.1176/appi.neuropsych.12090224
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Conflict of interest: Alain Dervaux has received honoraria for lectures from Bristol-Myers Squibb, Lundbeck, and Lilly. The other authors declare no conflicts of interest.

Service d’Addictologie du Centre Hospitalier Sainte-Anne
Paris, France

Service d’Addictologie de la Polyclinique La Concorde
Alfortville, France

Correspondence: Dr Alain Dervaux; e-mail: a.dervaux@ch-sainte-anne.fr

Copyright © 2013 by the American Psychiatric Association

Extract

To the Editor: The risk factors of torsade de pointes are: drug-induced Q-Tc prolongation, female gender, hypokalemia, unrecognized congenital long Q-T syndrome (LQTS), and predisposing DNA polymorphisms.1,2 These risk factors have not been studied in patients receiving methadone, a drug associated with Q-Tc interval prolongation, with a dose–effect relationship.2,3 Also, drug-induced Q-Tc prolongation can be a potentially dangerous adverse effect of medication combinations. Most of the torsade de pointes caused by polypharmacy, including methadone, were reported in patients with human immunodeficiency virus (HIV). We report the case of a patient on stable methadone treatment, without HIV infection, whose condition suddenly worsened with hidden laxative abuse.

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References

Sauer  AJ;  Newton-Cheh  C:  Clinical and genetic determinants of torsade de pointes risk.  Circulation 2012; 125:1684–1694
[CrossRef] | [PubMed]
 
Stringer  J;  Welsh  C;  Tommasello  A:  Methadone-associated Q-T interval prolongation and torsades de pointes.  Am J Health Syst Pharm 2009; 66:825–833
[CrossRef] | [PubMed]
 
Krantz  MJ;  Martin  J;  Stimmel  B  et al:  Q-Tc interval screening in methadone treatment.  Ann Intern Med 2009; 150:387–395
[CrossRef] | [PubMed]
 
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