Cardiac Effects of Opioid Therapy

Abstract

Objective: The use of opioids to treat chronic pain has come under increased scrutiny, as such use has been associated with significant risk of death, with limited data regarding the long-term effectiveness, especially when used to treat noncancer pain. The purpose of this manuscript is to discuss the cardiac effects associated with long-term opioid therapy. Design: A literature search was performed using OVID. Results: Most opioids have little direct negative effect on cardiac contractility. However, opioid administration can be associated with decreased cardiac function when administered in combination with other medications, including benzodiazepines. Opioids can lead to bradycardia and vasodilation, and as a result can rarely lead to edema, hypotension, orthostatic hypotension, and syncope when used at analgesic doses. While most opioids have no effect on cardiac conductivity, methadone, and buprenorphine can prolong QTc, especially when used in patients at increased risk for QTc prolongation. Electrocardiogram (ECG) monitoring of QTc at baseline and following dose increases is appropriate in patients receiving these medications. Conclusions: There are limited data to suggest that chronic opioid administration may be associated with an increased risk for cardiac-related adverse effects. However, this observation has not yet been confirmed. Regardless, while opioids are an important medication for the treatment of a multitude of chronic pain conditions, careful patient selection, and diligent monitoring is likely to decrease the risk of harm and improve patient outcomes.