struct
cfdumpinited false
ckittyid 6464
dsource Providers
ext .cfm
file_separator /
group_filepath /www/sites/mfapp/templates/groups/
group_info
struct
IHG Integration API 2.0 NO
PIURL [empty string]
SITEMESSAGE
component net.medfusion.cfcs.sitebroadcast
DATASOURCE Providers
METHODS
GETMESSAGE
function getMessage
Arguments:
Name Required Type Default
groupid Required numeric  
clearcache Optional boolean false
ReturnType: string
Roles:  
Access: public
Output: No
DisplayName:  
Hint:  
Description:  
activate NO
append_url gid=7281&muu=7935
appts NO
ars NO
askadoc NO
bbs NO
contactus 1
cs_email patientservices@medfusion.net
docs NO
egqenabled NO
em NO
family 0
forms2 NO
forms3 NO
fsu NO
group_alias [empty string]
group_id 7281
group_name TO CREATE (Options in Health Care and Education)
group_size 0
group_type F
group_url www.2create.yourmd.com
hform NO
hkey YES
house NO
ifx NO
imh NO
insurance NO
inteng NO
kiosk NO
lab NO
lite NO
loc_url www.2create.yourmd.com
logo 0
mfpay NO
mfpid 10
mfplogo [empty string]
mfplus NO
mfpname Medem
mfpportaldescription [empty string]
mfpurl [empty string]
mobile NO
mu NO
mu rpt denom NO
muu 7935
mylabs 0
nexsched NO
npp 0
paymybill NO
pers_search 0
personnel 0
phr NO
phys_search 0
portal 1
pph 0
practiceid 17134
prefix http://www.medfusion.net
prime_id 12783
reception NO
referral NO
report NO
reqssn 0
rx NO
secureprefix https://www.medfusion.net
splash 0
status 1
style 0
support NO
temp_id 1376
tplan NO
tvd NO
vcs NO
vov NO
wmd NO
loc_info
struct
loc_id 12783
prime_ind 1
menu
array
1
array
1 14
2 faq
3 0
4 82785
5 1
6 Frequently Asked Questions
2
array
1 18
2 patient_education
3 0
4 82786
5 1
6 Patient Education
3
array
1 6287
2 drug_testing
3 7281
4 82640
5 1
6 [empty string]
4
array
1 6426
2 services_offered_by_2create,_inc
3 7281
4 82787
5 1
6 [empty string]
5
array
1 6430
2 specific_topics_&_resources:
3 7281
4 82789
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6 [empty string]
6
array
1 6436
2 2009_gw_topics_course:drug_abuse
3 7281
4 82790
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7
array
1 6439
2 papers_from_gw_drug_abuse_course
3 7281
4 82791
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6 [empty string]
8
array
1 6445
2 evidence_based_medicine_(ebm)
3 7281
4 82794
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9
array
1 6446
2 other_epidemiology
3 7281
4 82795
5 1
6 [empty string]
10
array
1 6448
2 oat_(methadone)_patient_advocacy
3 7281
4 82797
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6 [empty string]
11
array
1 6449
2 confidentiality_(42cfr2)
3 7281
4 82798
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12
array
1 6452
2 co-occurring_disorders
3 7281
4 82800
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13
array
1 6454
2 drug_abuse_medical_complications
3 7281
4 82801
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14
array
1 6455
2 rate_hypothesis_(pk_&_reward)
3 7281
4 82802
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15
array
1 6457
2 medical_risk_management_&_nsep
3 7281
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16
array
1 6458
2 hallucinogens,_etc.
3 7281
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array
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array
1 6463
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array
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3 7281
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6 [empty string]
20
array
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21
array
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3 7281
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array
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3 7281
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24
array
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3 7281
4 82814
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25
array
1 6471
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3 7281
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26
array
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3 7281
4 82816
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27
array
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3 7281
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array
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3 7281
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29
array
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3 7281
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30
array
1 6483
2 homeopathy
3 7281
4 82821
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31
array
1 6484
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3 7281
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32
array
1 6485
2 holistic_nursing
3 7281
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33
array
1 6487
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3 7281
4 82825
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34
array
1 6489
2 medical_organizations
3 7281
4 82827
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6 [empty string]
35
array
1 6492
2 aa
3 7281
4 82489
5 1
6 [empty string]
36
array
1 6493
2 history_&_politics_of_altmed
3 7281
4 82490
5 1
6 [empty string]
37
array
1 6495
2 emf_(electric_&_magnetic_fields)
3 7281
4 82492
5 1
6 [empty string]
38
array
1 6496
2 cyber-psychology_mind&meditation
3 7281
4 82493
5 1
6 [empty string]
39
array
1 6497
2 placebo_nocebo
3 7281
4 82494
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6 [empty string]
40
array
1 6498
2 treatment_behind_bars
3 7281
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6 [empty string]
41
array
1 6499
2 other_mental_health
3 7281
4 82496
5 1
6 [empty string]
42
array
1 6500
2 other_health_science_policy
3 7281
4 82497
5 1
6 [empty string]
43
array
1 6501
2 lymphedema
3 7281
4 82498
5 1
6 [empty string]
44
array
1 6515
2 liver_transplant_in_oat_patients
3 7281
4 82608
5 1
6 [empty string]
45
array
1 6521
2 mad_in_europe
3 7281
4 82614
5 1
6 [empty string]
46
array
1 6523
2 dual_diagnoses
3 7281
4 82616
5 1
6 [empty string]
47
array
1 6524
2 alternative_rx_&_public_health
3 7281
4 82617
5 1
6 [empty string]
48
array
1 6527
2 religion_or_healthcare
3 7281
4 82620
5 1
6 [empty string]
49
array
1 6528
2 psychoactive_botanicals
3 7281
4 82621
5 1
6 [empty string]
50
array
1 6531
2 first_nations_health_data_bases
3 7281
4 82624
5 1
6 [empty string]
51
array
1 6533
2 animal_research
3 7281
4 82626
5 1
6 [empty string]
52
array
1 6537
2 online_analysis_of_drug_data
3 7281
4 82630
5 1
6 [empty string]
53
array
1 6543
2 useful_medical_links
3 7281
4 82830
5 1
6 [empty string]
self index.cfm
site_filepath /www/sites/mfapp/templates/main/
 
TO CREATE (Options in Health Care and Education)  
     
     
Qt Prolongation,TdP,Cardiac&LAAM
AATOD (formerly AMTA) Expert Panel Clinical Guidelines on LAAM

Other Drugs besides LAAM that prolong QT interval and may predispose to Torsades de Pointes (TdP) / WebLink

European Actions on LAAM / EMEA

European Drug Agency Monograph on LAAM / EMEA

Polymorphous ventricular tachycardia (Torsade de pointes) / WebLink

Long QT interval / WebLink

What is the long Q-T syndrome (LQTS)? / WebLink

LAAM information from Roxane / WebLink

LAAM Information from the European Agency for the Evaluation of Medicinal Products (EMEA) / WebLink

OrLAAM Label / Roxane Laboratories

New Prescribing Information / Roxane Laboratories

Roxane's OrLAAM Website / WebLink

Sudden Cardiac Death in the United States,
1989 to 1998
Zhi-Jie Zheng, MD, PhD; Janet B. Croft, PhD; Wayne H. Giles, MD, MS;George A. Mensah, MD (Circulation. 2001;104:2158)

Long QT Syndrome and other channelopathies


Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome
JOHN S. MEYER, M.D, et al; in:(Am Fam Physician 2003;68:483-8. American Academy of Family Physicians.) http://www.aafp.org/afp/20030801/483.html


Letters
Page 307 19 August 2003 Annals of Internal Medicine Volume 139 ? Number 4

Torsade de Pointes Due to Methadone
TO THE EDITOR: We read the paper by Krantz and colleagues (1)
about torsades de pointes in patients treated with methadone. In our
hospital, four HIV-infected patients receiving methadone therapy
presented with episodes of syncope. All of them had a prolongation
of the corrected QT interval (QTc) (0.45 seconds) and several
episodes of torsades de pointes. All of the patients were men, and the
mean age was 35 years. When the syncope occurred, two patients
had AIDS and three were taking antiretroviral therapy with reverse
transcriptase inhibitors. The mean daily methadone dose was 365
mg (range, 275 to 500 mg), and the mean QTc interval was 0.59
seconds (range, 0.51 to 0.64 seconds). Three patients had mild echocardiographic
abnormalities, namely ventricular dilatation and hypokinetic
areas; two had ionic disorders (potassium level, 2.9 mmol/L;
ionized calcium level, 0.95 mmol/L [3.8 mg/dL]); and three were
simultaneously taking potentially arrhythmogenic drugs (clarithromycin,
foscarnet, and cotrimoxazole). Furthermore, we cannot rule
out the possibility that these patients were adult carriers of a silent
genetic anomaly. We were able to reduce the methadone dose in
three of four patients and, of interest, observed a shortening of the
QT interval. The resulting mean QTc interval was 0.47 second
(range, 0.38 to 0.57 second).
The long QT syndrome related to viral cardiomyopathies or
autonomous neuropathies has been described in HIV-infected patients
(2, 3) but is usually related to drugs (macrolides, quinolones,
clindamycin, trimethoprim?sulfamethoxazole, fluconazole, foscarnet,
and pentamidine). Methadone affects several variables of cardiac
function and has a negative inotropic and chronotropic effect in vitro
(4). Antiretroviral therapy increases drug interactions by the inhibition
and induction of cytochrome P450, and higher doses of methadone
are used when the drug is given with non-nucleoside reverse
transcriptase inhibitors.
Although all of our patients had nonpharmacologic factors that
may potentially prolong the QT interval, the sequence of events
suggests that methadone caused the prolongation and provided the
substrate for torsades de pointes.
Montserrat Sala, MD
Ignasi Anguera, MD
Manuel Cervantes, MD
Institut Universitari Parc Taulý´, Hospital de Sabadell
08208 Sabadell, Barcelona, Spain
References
1. Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS.
Torsade de pointes associated with very-high-dose methadone. Ann Intern Med. 2002;
137:501-4. [PMID: 12230351]
2. Kocheril AG, Bokhari SA, Batsford WP, Sinusas AJ. Long QTc and torsades de
pointes in human immunodeficiency virus disease. Pacing Clin Electrophysiol. 1997;
20:2810-6. [PMID: 9392812]
3. Villa A, Foresti V, Confalonieri F. Autonomic neuropathy and prolongation of QT
interval in human immunodeficiency virus infection. Clin Auton Res. 1995;5:48-52.
[PMID: 7780290]
4. Mantelli L, Corti V, Bini R, Cerbai E, Ledda F. Effects of dl-methadone on the
response to physiological transmitters and on several functional parameters of the isolated
guinea-pig heart. Arch Int Pharmacodyn Ther. 1986;282:298-313. [PMID:
2876691]
TO THE EDITOR: Krantz and colleagues (1) did an exceptional job in
analyzing a possible association between very high doses of methadone
and torsades de pointes. We report the case of a 41-year-old
woman admitted to the hospital for syncope. During initial evaluation
in the emergency department, the patient was found to have
torsades de pointes. The QTc interval was found to be 550 milliseconds
(2). The patient had no family history of arrhythmias. Potassium
level was 3.6 mmol/L, and magnesium level was 0.62 mmol/L.
A urine drug screening test was positive for methadone. The patient
eventually had echocardiography, which showed no structural heart
disease, and cardiac catheterization, which confirmed that her coronary
arteries were normal. She subsequently had a defibrillator implanted
and was discharged.
We certainly feel that there is an association between methadone
use and torsades de pointes (3). However, like Krantz and
colleagues, we were unable to rule out congenital prolonged QT
interval (4). Also, we could not confirm the actual dosage of methadone
the patient was receiving before her arrhythmia, since she was
obtaining methadone from her significant other and was not enrolled
in a treatment program.
Evan O. Mokwe, MD
Opara Ositadinma, MD
Wayne State University
Detroit, MI 48201
References
1. Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS.
Torsade de pointes associated with very-high-dose methadone. Ann Intern Med. 2002;
137:501-4. [PMID: 12230351]
2. Viskin S. Long QT syndromes and torsade de pointes. Lancet. 1999;354:1625-33.
[PMID: 10560690]
3. Deamer RL, Wilson DR, Clark DS, Prichard JG. Torsades de pointes associated
with high dose levomethadyl acetate (ORLAAM). J Addict Dis. 2001;20:7-14.
[PMID: 11760927]

www.annals.org Annals of Internal Medicine Volume ? Number E-307


9/9/2003-LAAM BEING DISCONTINUED IN US(http://www.fda.gov/cder/drug/shortages/orlaam.htm)
(http://www.fda.gov/medwatch/SAFETY/2003/safety03.htm#orlaam)

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Wed, 14 Aug 2002 22:15:08 -0400 (EDT)

From: Stew202@aol.com

Message-ID: <1bd.ade43c6.2a8c68ac@aol.com>

Date: Wed, 14 Aug 2002 22:15:08 EDT

Subject: Fwd: Some patients prefer LAAM

To: ATrachte@samhsa.gov, ATrachte@juno.com, RLubran@samhsa.gov

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I thought you might be interested in this commentary from Andrew Byrne about

a study conducted in Australia.


Patterns of and reasons for LAAM preference are similar to what we've seen

before. Unfortunately, the study design and execution has typical flaws and

biases of much research in addiction medicine: eg, questionable subject

selection, high drop out rates serving to derandomize the study, likely

suboptimal doses of methadone and LAAM, etc.


Regards,

Stew


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I thought you might be interested in this commentary from Andrew Byrne about a study conducted in Australia.





Patterns of and reasons for LAAM preference are similar to what we've seen before. Unfortunately, the study design and execution has typical flaws and biases of much research in addiction medicine: eg, questionable subject selection, high drop out rates serving to derandomize the study, likely suboptimal doses of methadone and LAAM, etc.





Regards,


                  Stew



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Message-ID: <3D5AF28B.957FD386@ozemail.com.au>

Date: Thu, 15 Aug 2002 10:15:08 +1000

From: Andrew Byrne

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To: Andrew Byrne

Subject: Some patients prefer LAAM, and they used less heroin, too. Adelaide

study.

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White JM, Danz C, Kneebone J, La Vincente SF, Newcombe DAL,

Ali RL. Relationship between LAAM-methadone preference and

treatment outcomes. Drug and Alcohol Dependence (2002)

66:295-301


Dear Colleagues,


This excellent paper examines 62 stable methadone (MMT) patients

who received LAAM (L alpha methadol) second daily and

methadone daily each for two 3 month periods, randomised and

'crossed-over'. They were then permitted their choice of either

agonist drug for a further 6 months while drug use and other

outcomes were examined using self report and hair testing. Take-

away doses were permitted on clinical grounds. In the case of

methadone, 2-4 per week were permitted in a third of cases with a

further 10% receiving occasional dispensed doses. Half the trial

subjects received no take-away methadone doses 'on clinical

grounds'. Proportionately fewer LAAM doses were given due to

second daily attendance.


Nine patients withdrew from the study due to side effects from

LAAM. A further 11 patients refused to comply with the protocols

or were expelled from treatment 'for disciplinary reasons'. Only 39

of the original 62 'stable' MMT patients remained in treatment after

the first part of the study and thus were able to choose their agonist

drug for the second 6 month phase of the study.


At the end of the first phase of the study two thirds of patients

preferred LAAM with one third opting for the original methadone.

The reasons given for the LAAM preference were 'less withdrawals'

(40%), 'fewer side effects' (30%), 'less craving for heroin' (18%)

and 'fewer pick-up days' (14%). LAAM appeared to cause lower

rates of heroin use based on concentrations of morphine in hair

analysis and self report. The rates were extremely low, quoted as

one to three days per month, the lower figure applying to the

LAAM patients. Hair analysis was consistent (0.14 vs 0.31 ng/mg

morphine). Other drug use was comparable between the two

groups (benzodiazepines, stimulants, opiates, 'street' methadone

and cocaine).


The mean age was 35 years, half the subjects being male. The

mean daily methadone dose rose from 70mg to 77mg at the end of

the trial (range 20-150mg). A 1996 report from these authors

quoted a mean methadone dose after a 'streaming' intervention at

63mg. LAAM average dose was 82mg consistent with the 1.1

conversion ratio quoted. It is stated that patients with prolonged

QT interval on ECG were excluded from the study but we are not

told how many this applied to, if any. We are also told that if the

rare cardiac conduction complications were resolved, "LAAM has

the potential to be an important pharmacotherapy ... reserved for

those for whom methadone is not satisfactory". This would place it

in a similar category to buprenorphine.


It is unfortunate that this drug was prescribed so widely in America

for non-clinical reasons, sometimes apparently for the convenience

of the clinic, being second daily. With a rare but potentially serious

side effect, it is understandable that drug companies are less

enthusiastic about it. If it is not one 'American disease', it is

another.


comments by Andrew Byrne ..


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dr Andrew Byrne,

Medical Practitioner, Drug and Alcohol,

75 Redfern Street, Redfern,

New South Wales, 2016,

Australia

Tel (61 - 2) 9319 5524 Fax 9318 0631

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





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