Stereoselective block of hERG channel by (S)-methadone and QT interval prolongation in CYP2B6 slow metabolizer: Evidence of a safer cardiac profile of (R)-methadone

Eap, Chin Bin; Crettol, Séverine; Rougier, J.S.; Schlaepfer, J.; Sintra Grilo, Liliana; Déglon, J.J.; Besson, J.; Croquette-Krokar, M.; Carrupt, Pierre-Alain; Abriel, Hugues

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Title		Stereoselective block of hERG channel by (S)-methadone and QT interval prolongation in CYP2B6 slow metabolizer: Evidence of a safer cardiac profile of (R)-methadone
Authors		Eap, Chin Bin Crettol, Séverine Rougier, J.S. Schlaepfer, J. Sintra Grilo, Liliana Déglon, J.J. Besson, J. Croquette-Krokar, M. Carrupt, Pierre-Alain Abriel, Hugues show all authors [1 - 10]
Published in		Pharmacopsychiatry. 2008, vol. 41, p. 207-208
Abstract		Methadone inhibits the cardiac potassium channel hERG and can cause a prolonged QT interval. Methadone is chiral but its therapeutic activity is mainly due to (R)-methadone. Whole-cell patch-clamp experiments using cells expressing hERG showed that (S)-methadone blocked the hERG current 3.5-fold more potently than (R)-methadone (IC50s (half-maximal inhibitory concentrations) at 37 degrees C: 2 and 7 microM). As CYP2B6 slow metabolizer (SM) status results in a reduced ability to metabolize (S)-methadone, electrocardiograms, CYP2B6 genotypes, and (R)- and (S)-methadone plasma concentrations were obtained for 179 patients receiving (R,S)-methadone. The mean heart-rate-corrected QT (QTc) was higher in CYP2B6 SMs (6/6 genotype; 439+/-25 ms; n=11) than in extensive metabolizers (non 6/6; 421+/-25 ms; n=168; P=0.017). CYP2B6 SM status was associated with an increased risk of prolonged QTc (odds ratio=4.5, 95% confidence interval=1.2-17.7; P=0.03). This study reports the first genetic factor implicated in methadone metabolism that may increase the risk of cardiac arrhythmias and sudden death. This risk could be reduced by the administration of (R)-methadone.
Keywords		Adult — Alleles — Analgesics, Opioid/blood/chemistry/pharmacology — Aryl Hydrocarbon Hydroxylases/metabolism — DNA, Complementary/biosynthesis/genetics — Electrocardiography/drug effects — Ether-A-Go-Go Potassium Channels/drug effects — Female — Genotype — Heart Rate/drug effects — Humans — Kinetics — Long QT Syndrome/chemically induced/genetics/physiopathology — Male — Methadone/blood/chemistry/pharmacology — Middle Aged — Oxidoreductases, N-Demethylating/*metabolism — Patch-Clamp Techniques — Potassium Channel Blockers — Reverse Transcriptase Polymerase Chain Reaction — Stereoisomerism
Identifiers		DOI: 10.1055/s-0028-1088244
Full text		Article (Published version) (157 Kb) - Limited access to UNIGE
Structures		Faculté des sciences / Section des sciences pharmaceutiques
Citation (ISO format)		EAP, Chin Bin et al. Stereoselective block of hERG channel by (S)-methadone and QT interval prolongation in CYP2B6 slow metabolizer: Evidence of a safer cardiac profile of (R)-methadone. In: Pharmacopsychiatry, 2008, vol. 41, p. 207-208. https://archive-ouverte.unige.ch/unige:4087