The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
Editor, – Thank you to Michael McDonough for his comprehensive article on the safe prescribing of opioids (Aust Prescr 2012;35:20-4 ). In particular, Table 1 provides useful recommendations for the monitoring and management of possible emerging adverse effects.
The inclusion of oxycodone as a medication which prolongs QTc was surprising. This precaution does not appear in other sources of information discussing oxycodone, such as the reference cited for Table 11 , the approved product information for oxycodone, the Australian Medicines Handbook,2 Therapeutic Guidelines3 or the database which records medications that prolong QTc (www.qtdrugs.org). However, there has been research published which supports the occurrence of prolonged QTc by oxycodone in a dose-dependent manner.4 Is there any other literature that the author can refer us to which supports the prolongation of QTc by oxycodone?
The suggested strategy to manage this potential adverse effect in his article is to recommend an ECG. Given that the prescribing of oxycodone and oxycodone-related deaths have increased in Australia since 2002,5 does the author, as a practical consideration, advise that in all cases an ECG be performed before the initiation of all formulations of oxycodone?
Illawarra Shoalhaven Medicare Local
Clinical pharmacist and NPS facilitator
Drug and Therapeutics Information Service (DATIS)
Repatriation General Hospital, Adelaide
- Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efﬁcacy and safety. Pain 2004;112:372-80.
- Australian Medicines Handbook. Adelaide: AMH; 2012.
- eTG complete [internet]. Melbourne: Therapeutic Guidelines Limited; 2012.
- Fanoe S, Boje JensenG, Sjøgren P, Korsgaard MP, Grunnet M. Oxycodone is associated with dose-dependent QTc prolongation in patients and low-afﬁnity inhibiting of hERG activity in vitro. Br J Clin Pharmacol 2009;67:172-9.
- Roxburgh A, Bruno R, Burns L. Prescription of opioid analgesics and related harms in Australia. Med J Aust 2011;195:280-4.
- Fanoe S, Boje Jensen G, Sjøgren P, Korsgaard MP, Grunnet M. Oxycodone is associated with dose-dependent QTc prolongation in patients and low-afﬁnity inhibiting of hERG activity in vitro. Br J Clin Pharmacol 2009;67:172-9.
- Rintoul AC, Dobbin MD, Drummer OH, Ozanne-Smith J. Increasing deaths involving oxycodone, Victoria, Australia, 2000-09. Inj Prev 2011;17:254-9.
- Hall WD, Farrell MP. Minimising the misuse of oxycodone and other pharmaceutical opioids in Australia [editorial]. Med J Aust 2011;195:248-9.
- Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc Interval Screening in methadone treatment. Ann Intern Med 2009;150:387-95.