March 26, 2026

1108: Evaluation of Dose-Dependent Association of Methadone to QTC Prolongation in Pediatric Patients

NCNicole CastoroUniversity at Buffalo, State University of New York XHXinyi Huang DSDavid M. SalernoCornell University

Key Result

Methadone increased QTc intervals from baseline (417 vs 435 ms) in pediatric patients, but showed no dose-dependent correlation with QTc prolongation (r=-0.02).

Key Points

To determine the dose-dependent relationship between methadone and QTc prolongation in pediatric patients.
Retrospective chart review of patients < 18 years old on methadone
Included patients from ICU settings, January 2023 to April 2024
Excluded patients with certain conditions and those on methadone for specific indications
Evaluated QTc values and identified prevalence of QTc prolongation
Included 140 pediatric patients with average age of 1 year
34.1% of QTc values observed were prolonged (QTc ≥ 450 ms)
No correlation found between methadone dose and QTc interval (r=-0.02)
Significant change observed in QTc from baseline (417 to 435 ms, p=0.0018), but not clinically significant
No torsades de pointes events were observed

Structured PICO

Does weight-based methadone dose correlate with the degree of QTc prolongation in pediatric intensive care patients?

Population

140 pediatric patients < 18 years old initiated on methadone in the intensive care setting, average age 1 year, 58.6% male. Excluded: methadone < 24 hours, no EKG results while on methadone, history of long QT syndrome, renal dysfunction, or methadone for chronic pain, palliative care, and/or addiction.

Intervention

Methadone (various weight-based doses)

Comparator

Baseline (pre-methadone) QTc

Outcome

Dose-dependent relationship between methadone and QTc prolongationsafety

In pediatric intensive care patients, methadone use is associated with a statistically significant but clinically modest increase in QTc interval, with no dose-dependent correlation observed.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Introduction: Methadone is utilized in pediatric acute care setting in the peri-extubation period when weaning off opioid infusions in order prevent iatrogenic withdrawal syndrome. Methadone is associated with prolongation of the QTc interval. The specific relationship between the degree of QTc prolongation and various weight-based doses of methadone has not been characterized. The primary aim of this study was to determine and characterize the dose dependent relationship between methadone and QTc prolongation in pediatric patients. Methods: A retrospective chart review of patients less than 18 years old initiated on methadone between January 1, 2023 and April 30, 2024, in the intensive care setting. Patients were excluded if they received methadone for 450 ms and >500 ms), diagnosis of torsades de pointes, and percentage of QTc prolongation with concomitant QTc prolonging and CYP3A4 drugs compared to methadone monotherapy. Results: A total of 140 pediatric patients were included. The average age was 1 year old (IQR 0.24-0.55), the majority were male (58.6%). A total of 1010 QTc values were assessed. QTc prolongation, defined as a QTc ≥ 450 ms, was observed in 34.1% of QTcs reviewed. There was no correlation between weight-based methadone dose and QTc interval (r=-0.02). There was a statistically significant change between baseline QTc and QTc while on methadone (417 versus 435, p=0.0018); however, this was not clinically significant. No events of torsade de pointes were observed. Conclusions: While receipt of methadone demonstrated a prolongation of QTc above baseline, we could not identify that increasing doses of methadone provided further prolongation to the QTc interval.

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