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In Reply: We appreciate the discussion by Dr Krantz and colleagues of the emerging data regarding methadone's effect on the QT interval and the occurrence of torsades de pointes.

In response to all of these letters, we would like to clarify that we purposely sought experts' advice on selected medications with respect to whether the experts would measure the QT interval on an ECG before and after initiating these drugs. This information is summarized in the Box in our article. Among the considerations in this advice are not only objective data in the literature but also the practicality and cost-effectiveness of such an approach. We sought to understand how experts assimilate the available literature, despite its inconsistencies, with their professional experience and how they translate this into practice recommendations.

Although the expert panel we mentioned in our article was held in August 2000, our survey of experts was conducted in . . . [Full Text of this Article]

Sana M. Al-Khatib, MD, MHS; Nancy M. Allen LaPointe, PharmD; Judith M. Kramer, MD, MS; Robert M. Califf, MD
Duke Center for Education and Research on Therapeutics
Duke Clinical Research Institute
Durham, NC

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