Should baseline/routine ECG monitoring be performed for patients on buprenorphine-containing medications?

Kayla Boedeker; Megan Fraley; Sarah Toppins; Chris Herndon

doi:10.5055/jom.0890

Authors

Kayla Boedeker, PharmD
Megan Fraley, PharmD
Sarah Toppins, PharmD
Chris Herndon, PharmD, FCCP

DOI:

https://doi.org/10.5055/jom.0890

Keywords:

buprenorphine, ECG monitoring

Abstract

While buprenorphine has gained widespread use in the treatment of opioid use disorder (OUD), this agent is becoming increasingly popular as a primary analgesic in those persons with pain severe enough to require chronic opioid therapy.

Author Biographies

Kayla Boedeker, PharmD

Pharmacist, Walgreen's, St. Charles, Missouri

Megan Fraley, PharmD

PGY-1 Pharmacy Resident, Banner University Medical Center, Tucson, Arizona

Sarah Toppins, PharmD

PGY-2 Pain & Palliative Care Pharmacy Resident, VA St. Louis Healthcare System, St. Louis, Missouri

Chris Herndon, PharmD, FCCP

Professor, Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, Illinois; Clinical Associate Professor, Department of Community and Family Medicine, St. Louis University School of Medicine, St. Louis, Missouri

References

Harris SC, Morganroth J, Ripa SR, et al.: Effects of buprenorphine on QT intervals in healthy subjects: results of 2 randomized positive- and placebo-controlled trials. Postgrad Med. 2017; 129(1): 69-80. DOI: 10.1080/00325481.2017.1270156.

Giudicessi JR, Noseworthy PA, Ackerman MJ: The QT Interval: An Emerging Vital Sign for the Precision Medicine Era? Circulation. 2019; 139(24): 2711-2713. DOI: 10.1161/CIRCULATIONAHA.119.039598.

Khatib R, Sabir FRN, Omari C, et al.: Managing drug-induced QT prolongation in clinical practice. Postgrad Med J. 2021; 97(1149): 452-458. DOI: 10.1136/postgradmedj-2020-138661.

Drew BJ, Ackerman MJ, Funk M, et al.: Prevention of torsade de pointes in hospital settings: A scientific statement from the American heart association and the American college of cardiology foundation. Circulation. 2010; 121(8): 1047-1060. DOI: 10.1161/CIRCULATIONAHA.109.192704.

Darpo B, Zhou M, Bai SA, et al.: Differentiating the Effect of an Opioid Agonist on Cardiac Repolarization from m-Receptor-mediated, Indirect Effects on the QT Interval: A Randomized, 3-way Crossover Study in Healthy Subjects. Clin Ther. 2016; 38(2): 315-326. DOI: 10.1016/j.clinthera.2015.12.004.

Tran PN, Sheng J, Randolph AL, et al.: Mechanisms of QT prolongation by buprenorphine cannot be explained by direct hERG channel block. PLoS One. 2020; 15(11 November). DOI: 10.1371/journal.pone.0241362.

Frost M, Bailey GL, Lintzeris N, et al.: Long-term safety of a weekly and monthly subcutaneous buprenorphine depot (CAM2038) in the treatment of adult out-patients with opioid use disorder. Addiction. 2019; 114(8): 1416-1426. DOI: 10.1111/add.14636.

Isbister GK, Brown AL, Gill A, et al.: QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings. Br J Clin Pharmacol. 2017; 83(10): 2274-2282. DOI: 10.1111/bcp.13326.

Wang L, Volkow ND, Berger NA, et al.: Cardiac and mortality outcome differences between methadone, buprenorphine and naltrexone prescriptions in patients with an opioid use disorder. J Clin Psychol. Published online 2023. DOI: 10.1002/jclp.23582.