Evaluating the risk of methadone and QTc interval prolongation in an oncologic population

In this large retrospective cohort of oncology patients receiving methadone for pain management, methadone was associated with a small but statistically significant increase in QTc interval ≥12 months after starting therapy, with a mean increase of approximately 4 ms. This magnitude of QTc change is unlikely to produce meaningful clinical manifestations for most patients. These findings support the low risk of QTc prolongation for most patients with cancer taking methadone and encourage a risk-stratified approach to methadone use in cancer pain with targeted ECG monitoring regimens for patients with elevated baseline QTc or underlying cardiac disease.