Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature
Introduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-07-01
|
| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/15/7/1084 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849303520979714048 |
|---|---|
| author | Buzatu Georgiana Cristina Sebastian Isac Geani-Danut Teodorescu Teodora Isac Cristina Martac Cristian Cobilinschi Bogdan Pavel Cristina Veronica Andreescu Gabriela Droc |
| author_facet | Buzatu Georgiana Cristina Sebastian Isac Geani-Danut Teodorescu Teodora Isac Cristina Martac Cristian Cobilinschi Bogdan Pavel Cristina Veronica Andreescu Gabriela Droc |
| author_sort | Buzatu Georgiana Cristina |
| collection | DOAJ |
| description | Introduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure in young adults is uncommon and often linked to genetic or infectious causes. We present a rare case of reversible cardiogenic shock and cerebellar insult due to methadone toxicity. Case Presentation: A 37-year-old man with a history of drug abuse on OST with methadone (130 mg/day) was admitted to the ICU with hemodynamic instability, seizures, and focal neurological deficits. Diagnostic workup revealed low cardiac output syndrome and a right cerebellar insult, attributed to methadone toxicity. The patient received individualized catecholamine support. After 10 days in the ICU, he was transferred to a general ward for ongoing cardiac and neurological rehabilitation and discharged in stable condition seven days later. Conclusions: Methadone-induced reversible left ventricular failure, particularly when accompanied by cerebellar insult, is rare but potentially life-threatening. Early recognition and multidisciplinary management are essential for full recovery in such complex toxicological presentations. |
| format | Article |
| id | doaj-art-9ff1141d0bf94155b8acdde4886a5c36 |
| institution | Kabale University |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj-art-9ff1141d0bf94155b8acdde4886a5c362025-08-20T03:58:26ZengMDPI AGLife2075-17292025-07-01157108410.3390/life15071084Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the LiteratureBuzatu Georgiana Cristina0Sebastian Isac1Geani-Danut Teodorescu2Teodora Isac3Cristina Martac4Cristian Cobilinschi5Bogdan Pavel6Cristina Veronica Andreescu7Gabriela Droc8Department of Anesthesiology and Intensive Care I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Internal Medicine II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Modern Languages, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, RomaniaIntroduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure in young adults is uncommon and often linked to genetic or infectious causes. We present a rare case of reversible cardiogenic shock and cerebellar insult due to methadone toxicity. Case Presentation: A 37-year-old man with a history of drug abuse on OST with methadone (130 mg/day) was admitted to the ICU with hemodynamic instability, seizures, and focal neurological deficits. Diagnostic workup revealed low cardiac output syndrome and a right cerebellar insult, attributed to methadone toxicity. The patient received individualized catecholamine support. After 10 days in the ICU, he was transferred to a general ward for ongoing cardiac and neurological rehabilitation and discharged in stable condition seven days later. Conclusions: Methadone-induced reversible left ventricular failure, particularly when accompanied by cerebellar insult, is rare but potentially life-threatening. Early recognition and multidisciplinary management are essential for full recovery in such complex toxicological presentations.https://www.mdpi.com/2075-1729/15/7/1084methadoneopioid substitution therapyleft ventricular failurecardiogenic shockbrain insultmultidisciplinary care |
| spellingShingle | Buzatu Georgiana Cristina Sebastian Isac Geani-Danut Teodorescu Teodora Isac Cristina Martac Cristian Cobilinschi Bogdan Pavel Cristina Veronica Andreescu Gabriela Droc Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature Life methadone opioid substitution therapy left ventricular failure cardiogenic shock brain insult multidisciplinary care |
| title | Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature |
| title_full | Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature |
| title_fullStr | Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature |
| title_full_unstemmed | Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature |
| title_short | Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature |
| title_sort | methadone induced toxicity an unexpected challenge for the brain and heart in icu settings case report and review of the literature |
| topic | methadone opioid substitution therapy left ventricular failure cardiogenic shock brain insult multidisciplinary care |
| url | https://www.mdpi.com/2075-1729/15/7/1084 |
| work_keys_str_mv | AT buzatugeorgianacristina methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT sebastianisac methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT geanidanutteodorescu methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT teodoraisac methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT cristinamartac methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT cristiancobilinschi methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT bogdanpavel methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT cristinaveronicaandreescu methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature AT gabrieladroc methadoneinducedtoxicityanunexpectedchallengeforthebrainandheartinicusettingscasereportandreviewoftheliterature |