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Darvon

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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1 in 12 drugs inappropriately prescribed to elderly
From Healthfacts, 3/1/04

Nearly 8% of the ambulatory medical care visits made by elderly people resulted in at least one inappropriate drug prescription, according to a survey reported in Archives of Internal Medicine (2/9/04). Urban women and white people made the majority of visits to physician offices and hospital outpatient departments.

Margie Rauch Goulding, PhD, of the U.S. Centers for Disease Control and Prevention, conducted the survey, which identified pain relievers and central nervous system drugs as making up the largest share of the inappropriately prescribed medicines. The two pain relievers are pentazocine (brand name: Talwin) and propoxyphene. The latter is sold under the brand names of Darvon, Darvon-N and prescribed in combination with acetaminophen (Tylenol) as Darvocet-N and Wygesic. Or sold as Darvon Compound, which combines propoxyphene, aspirin and caffeine. Propoxyphene is a narcotic that should be avoided by everyone, not just elderly people. Studies conducted over 20 years ago showed that it is no more effective as a pain reliever than aspirin or a placebo, even in people with cancer or postoperative pain. Furthermore, propoxyphene has the potential for addiction and overdose.

The inappropriately prescribed central nervous system drugs include barbiturates, tranquilizers, and antidepressants. Often, drugs in this category are prescribed to elderly people for insomnia, or in the case of antidepressants, for pain. The problem tranquilizers are flurazepam (Dalmane) chlordiazepoxide (Librium), meprobamate (Equanil, Miltown) and diazepam (Valium and others). The antidepressants that caused problems were from an older drug class amitriptyline (Elavil, Amitid) and doxepin (Sustiva).

Dr. Goulding found that the odds of having an inappropriate drug prescribed were double for women and high for any visit in which multiple drugs were prescribed. To determine what is an inappropriate drug for elderly people, Dr. Goulding drew on criteria developed by panels of experts in geriatric medicine. Inappropriate was defined as a drug that panel members agreed would have a risk of adverse effects that was larger than the potential benefits.

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