Q. I have PVC after starting Methadone. Will beta blockers help?

Answered by
Dr. Isaac Gana
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 13, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a 35 year old male, and I am currently on Methadone for chronic pain. I currently have PVC, and my last EKG showed a long QT (over 500 ms). The doctor recommended that I take Magnesium and Potassium supplements as he believes that Methadone may be reducing my magnesium and potassium levels. It has been a week now since I have been following the regime and currently the PVC is nearly gone. I do not have the option of reducing the Methadone due to my injury. The doctor said he wanted me to get an opinion from a cardiologist if I may need a beta blocker or not. He wants to wait to see how the supplementation works out first. Is there any advice you can give me? I get an EKG done twice a year.



Welcome to icliniq.com.

I have gone through your explanation in detail, and I understand your worries.

  • Long QT syndrome can predispose you to a fatal arrhythmia known as torsades de pointes. In your case, I will strongly advise you to commence treatment with a beta blocker. This is a safer option.
  • Not having PVC (premature ventricular contractions) does not eliminate your chances of a major cardiac event. Most of the time, patients in the same situation do not even present any symptom, and we only get to know when there is a major event.
  • I would like you to discuss the possibility of another pain medications with your physician to see if it will be possible to prescribe a safer alternative. In the meantime, you need a beta blocker, and Propranolol will be a good option. Get a follow-up EKG at least two weeks after commencement of beta blocker.

Best regards.

For further queries consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hello doctor,

Thank you for replying. I talked with my doctor and he prescribed Propranolol. He said he thinks they are benign because I have not fainted or passed out yet, and I do not have a family history of this. I cannot discontinue the Methadone because I go to a clinic and it is the only medication they dispense. Will beta blocker keep me safe? I have never had fast heartbeats or torsades de pointes before. My PVC are a pause then a flip flop and then a pause. They usually go away when I stand up or if my anxiety goes away.



Welcome back to icliniq.com.

  • Yes, what you are experiencing is because of using Methadone, and it can predispose you to torsade de pointes also. Automatically, if you stop Methadone, the long QT will be resolved.
  • But in your case, since you must use Methadone, I advise you keep using the Magnesium and Potassium supplements along with beta blockers. But not to scare you, this is not a 100 % guarantee. You have to be under the continuous supervision of your physician.
  • Your electrolyte level has to be regularly monitored along with an ECG. If after a while, the QT continuous to increase, a decision must be made to stop Methadone to prevent sudden cardiac death. This condition can also be caused by family history, but yours is not the case.

I sincerely wish you a quick recovery.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

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