Arrhythmia associated with buprenorphine and methadone reported to the food and drug administration. (September 2015)

• Record Type: Journal Article
• Authors: Kao, David P.; Haigney, Mark C. P.; Mehler, Philip S.; Krantz, Mori J.
• Is Part Of: Addiction. Volume 110:Number 9(2015:Sep.)
• Page Start: 1468
• Page End: 1475
• Publication Date: 2015-09
• Subjects: Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.13013
• Languages: English
• ISSNs: 0965-2140

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="add13013-sec-0001" sec-type="section"> <title>Aim</title> <p>To assess the relative frequency of reporting of adverse events involving ventricular arrhythmia, cardiac arrest, corrected QT interval (QTc) prolongation or torsade de pointes to the US Food and Drug Administration (FDA) between buprenorphine and methadone.</p> </sec> <sec id="add13013-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective pharmacoepidemiological study.</p> </sec> <sec id="add13013-sec-0003" sec-type="section"> <title>Setting</title> <p>Adverse drug events reported spontaneously to the FDA between 1969 and June 2011 originating in 196 countries (71% events from the United States).</p> </sec> <sec id="add13013-sec-0004" sec-type="section"> <title>Cases</title> <p>Adverse event cases mentioning methadone (<italic>n</italic> = 14 915) or buprenorphine (<italic>n</italic> = 7283) were evaluated against all other adverse event cases (<italic>n</italic> = 4 796 017).</p> </sec> <sec id="add13013-sec-0005" sec-type="section"> <title>Measurements</title> <p>The primary outcome was the composite of ventricular arrhythmia or cardiac arrest. The secondary outcome was the composite of QTc prolongation or torsade de pointes. The proportional reporting ratio (PRR) was used to identify disproportionate reporting defined as a PRR > 2, χ<sup>2</sup> error > 4, with ≥ 3 cases.</p> </sec> <sec id="add13013-sec-0006" sec-type="section"> <title>Findings</title> <p>There were 132 (1.8%) ventricular arrhythmia/cardiac arrest and 19 (0.3%) QTc prolongation/torsade de pointes cases associated with buprenorphine compared with 1729 (11.6%) ventricular arrhythmia/cardiac arrest and 390 (2.6%) QTc prolongation/torsade de pointes cases involving methadone. PRRs associated with buprenorphine were not significant for ventricular arrhythmia/cardiac arrest (1.10, 95%, confidence interval (0.93–1.31, χ<sup>2</sup> = 1.2) or QTc prolongation/torsade de pointes (1.03, 95% CI = 0.66–1.62, χ<sup>2</sup> = 0.01), but were for methadone (7.20, 95% CI = 6.88–7.52, χ<sup>2</sup> = 8027; 10.7, 95% CI = 9.66–11.8, χ<sup>2</sup> = 1538, respectively).</p> </sec> <sec id="add13013-sec-0007" sec-type="section"> <title>Conclusion</title> <p>In spontaneously reported adverse events, methadone is associated with disproportionate reporting of cardiac arrhythmias, whereas buprenorphine is not. Although these findings probably reflect clinically relevant differences, a causal connection cannot be presumed and disproportionality analysis cannot quantify absolute risk per treatment episode. Population‐based studies to definitively quantify differential incidence rates are warranted.</p> </sec> </abstract>