The structure of Dextropropoxyphene
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Dextropropoxyphene

Dextropropoxyphene is an analgesic in the opioid category. It is used to treat mild to moderate pain and as an antitussive. It can be used to ease pain before, during and after an operation. It is often combined with acetominophen in the preparation co-proxamol(Darvocet in the US). more...

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It is an optical isomer of Levopropoxyphene. The racemic mixture is called Propoxyphene.

Some preparations that contain dextropoxyphene include: Distalgesic and Doloxene.

The therapeutic index of dextropoxyphene is relatively small. In the UK, dextropoxyphene and co-proxamol are now discouraged from general use. Since 2004 preparations containing only dextropropoxyphene have been discontinued.

In the United States, dextropropoxyphene HCl is available as a prescription with acetaminophen in ratio anywhere from 30mg / 600mg to 60mg / 325mg, respectively. These are usually named "Darvocet," "Darvin," or "Darvon." Dextropropoxyphene is subject to some controversy: while many physicians prescribe it for a wide range of mildly to moderately painful symptoms as well as in treatment of diarrhoea, many others refuse to prescribe it, citing its highly addictive nature and limited effectiveness (some studies show it to be no more effective as a painkiller than aspirin).

Darvocet overdose is commonly broken into two categories: acetaminophen toxicity and dextropropoxyphene overdose. Many users experience toxic effects from the acetaminophen in pursuit of the endlessly-increasing dose required to achieve euphoria. They suffer acute liver toxicity, which causes severe stomach pain, nausea, and vomiting (all of which are increased by light or stimulation of the sense of sight).

Other users experience longer-term problems from consistent use of abusively high dextropropoxyphene levels. They take anywhere from 240 to 420 milligrams of dextropropoxyphene (and the acetaminophen that goes with it) in search of an increasingly elusive feeling of euphoria. These users often suffer a constantly dry mouth, decreased appetite, urinary retention and constipation. Because tolerance to dextropropoxyphene increases so quickly and because of its strong constipating effects, many people suffer a gruesome and painful rupture in the colon.


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Use of Opiates in Patients with Cancer
From American Family Physician, 2/1/01 by Anne D. Walling

(Hong Kong--The Hong Kong Practitioner, August 2000, p. 382.) Although opiates are the mainstay of analgesia in patients with cancer, they are frequently not given in adequate doses or are used inappropriately. Patients with cancer may experience different types of pain. Opiates are highly effective against visceral pain, partially effective in somatic and neuropathic pain, and not effective for pain caused by muscle spasm or psychosocial distress. Pharmacokinetics are important in the selection and prescription of opiates. Short-acting agents such as buprenorphine can be absorbed through the buccal mucosa and used to provide additional analgesia during procedures such as wound dressing. When long-acting agents such as dextropropoxyphene (half-life of 15 hours) are used, care must be taken to avoid an accumulation of metabolites. The most widely-used opioids are codeine and morphine. They should be provided in adequate doses to control pain and scheduled on a regular basis, not given "as needed." About seven doses are needed to reach the steady-state of effect, depending on whether the formulation is immediate or slow release. Initial nausea often resolves during the first few days, but the patient may need to use antiemetics. Severe vomiting may be caused by preservatives in the solution. Pharmacists can provide special formulations, but these require refrigeration. The dosage should be increased until pain is prevented without intolerable side effects. Double doses at bedtime may help the patient to sleep. Constipation is inevitable with opiate therapy, so concurrent use of a laxative is essential. Tolerance and physical dependence are not major problems when opiates are used appropriately in cancer therapy.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

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