To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Methadone, a long-acting opioid agonist commonly used in the treatment of opiate dependence, has been reported to cause QTc interval prolongation, increasing the risk of a fatal cardiac arrhythmia – Torsades-de-Pointes (TdP). This effect seems to be attributable to methadone's inhibitory effect on the cardiac “hERG”-K+ ion channel and is dose-dependent. There is a lack of consensus regarding when to perform an ECG for patients on methadone.
Identifying other TdPPRFs in a cohort of patients receiving ≥ 85 mg (high dose) methadone daily to inform local clinical safety guidelines.
Our outpatient caseload was filtered to select opiate-dependent patients receiving more than 85 mg methadone daily. Primary care summaries and laboratory results databases were analysed for the presence of other TdPPRFs: female sex a documented history of ECG abnormalities, electrolyte imbalance, liver or renal failure, and concomitant use of other QT prolonging medication or stimulants.
Fourteen opiate-dependent patients (10.29% of patients on methadone) were maintained on ≥ 85 mg methadone daily. Gender distribution was F:M = 1:1.8; 64% misused illicit stimulants; 57% were prescribed other QTc prolonging medication and 29% had a documented history of liver/renal failure or electrolyte imbalance. Only 14% had previous ECGs documented in primary care summaries. Of patients on high dose methadone, 85.7% had at least one TdPPRFs present and 64.3% had at least two.
These results demonstrate an increased rate of TdPPRFs in this patient group and highlight the importance of ECG monitoring which ideally should be offered to patients receiving even lower doses of methadone.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
With the national redesign of specialist mental health services and its move towards episodic care, community mental health teams in the UK face a challenge in transferring LAI patients to Primary Care. In North Bristol, anecdotal concerns had been raised about this, particularly in the absence of established shared care arrangements (SCAs), and these prompted this service evaluation.
To characterise the use of LAIs by NBRS.
1. To establish the prevalence of LAI prescriptions in NBRS and type of LAI prescribed.
2. To consider the resource implications and distribution of LAI patients by Primary Care surgery.
3. Using aims 1&2 to inform the development of local SCAs.
Use of a cross-sectional caseload survey of 523 out-patients under the care of NBRS on 1 September 2012.
LAIs were prescribed for 15% of the service’s total caseload (both psychotic and non-psyhcotic diagnoses). For those diagnosed with psychosis, flupentixol, risperidone and zuclopenthixol were most commonly prescribed, at mainly fortnightly or weekly injection intervals. The highest concentration of LAI patients were registered with Primary Care surgeries in areas reported as among the 10% most deprived nationally.
1. LAI prescribing practice in NBRS, for those with psychosis, was consistent with national practice.
2. Use of LAIs has particular resource implications for mental health teams.
3. Use of SCAs could facilitate the transfer of care of LAI patients to Primary Care.
Email your librarian or administrator to recommend adding this to your organisation's collection.