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Case Report

Vol. 21 No. 1 (2023)

Methadone Maintenance Therapy after Aneurysmal Subarachnoid Hemorrhage: A Case Report

August 17, 2021


There is limited information on the effects of continued methadone maintenance therapy following aneurysmal subarachnoid hemorrhage (aSAH). However, with the increasing incidence of opioid use disorder (OUD) in the US, there is a need to define best practices for the management of pain and prevention of acute withdrawal syndrome in patients with pre-existing OUD who develop aSAH.  In this case report, we describe the use of MMT in a patient with aSAH and discuss important considerations, including sedation or confusion that might mimic acute neurologic changes seen in cerebral vasospasm or delayed cerebral ischemia, cardiac complications related to QTc prolongation, and liver or kidney interactions associated with aSAH routine treatment. Our patient recovered from her aSAH without any adverse events and, with increased monitoring and collaborative team-based care, including input from those with expertise in OMD or aSAH, we believe MMT can be safely continued in most aSAH patients.


  1. Chang HY, Kharrazi H, Bodycombe D, Weiner JP, Alexander GC. Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study. BMC Med. 2018;16(1):69.
  2. Krambeer LL, von McKnelly W, Jr., Gabrielli WF, Jr., Penick EC. Methadone therapy for opioid dependence. Am Fam Physician. 2001;63(12):2404-2410.
  3. Toombs JD, Kral LA. Methadone treatment for pain states. Am Fam Physician. 2005;71(7):1353-1358.
  4. Grissinger M. Keeping patients safe from methadone overdoses. P T. 2011;36(8):462-466.
  5. Behzadi M, Joukar S, Beik A. Opioids and Cardiac Arrhythmia: A Literature Review. Med Princ Pract. 2018;27(5):401-414.
  6. Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. Excli j. 2015;14:577-600.
  7. Ahmad T, Valentovic MA, Rankin GO. Effects of cytochrome P450 single nucleotide polymorphisms on methadone metabolism and pharmacodynamics. Biochem Pharmacol. 2018;153:196-204. DOI:
  8. Volpe DA, Xu Y, Sahajwalla CG, Younis IR, Patel V. Methadone Metabolism and Drug-Drug Interactions: In Vitro and In Vivo Literature Review. J Pharm Sci. 2018;107(12):2983-2991.
  9. Ichinomiya T, Terao Y, Miura K, et al. QTc interval and neurological outcomes in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2010;13(3):347-354.
  10. Thomas SH, Behr ER. Pharmacological treatment of acquired QT prolongation and torsades de pointes. Br J Clin Pharmacol. 2016;81(3):420-427.


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