[Routine ECG in methadone-assisted rehabilitation is wrong prioritization].
The Norwegian Medicines Agency has recently reported dose-dependent QT prolongation and occurrence of Torsades des pointes in patients treated with methadone; the agency recommends that an ECG is taken before induction to methadone. We have performed a literature search in Medline and Embase. QT prolongation in methadone therapy is dose-dependent and primarily seen with doses higher than those usually used in maintenance therapy and/or in cases with known risk factors. Routine ECG should not be recommended, but before starting therapy the physician should secure an adequate case history including information on any family history of cardiac disease and other risk factors. ECG is recommended when doses higher than 130 mg/day are used or the serum concentration level exceeds 1200 nmol/l. QTc prolongation above 470 msek should be reported to the authors.