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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Corrections - to `Vitamin B may reduce risk of heart disease,' in Feb 14 issue; `Doctors to face disciplinary action over Irish hepatitis C scandal,' in
From British Medical Journal, 2/28/98

Vitamin B may reduce risk of heart disease: In the news item (14 February, p 498) it was wrongly stated that vitamin B6 levels of more than 4.6 [micro]g a day protects against heart disease. It should have stated 4.6 mg a day.

Doctors to face disciplinary action over Irish hepatitis C scandal: The news item (10 January, p 93) stated that Dr Jack O'Riordan died before the scandal broke. However, he is still alive and took part in the inquiry. The BMJ would like to apologise for any distress the error may have caused.

Systematic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol

An editorial error occurred in this paper by Li Wan Po and Zhang (13 December, pp 1565-71). In figure 2 the mean rate ratios (95% confidence intervals) for moderate to excellent pain relief between treatments should have been given as numbers [not as percentages, as published].

[Figure 2 ILLUSTRATION OMITTED]

Survival is better indicator than mortality in geographic, comparisons of health

An editorial error occurred in this letter by P A West (14 February, p 556). The wrong address was given for Dr West, who does not work for Berkshire Health Authority; his correct address is the Department of Public Health Medicine, Division of Public Health Sciences, UMPS, St Thomas's Hospital, London SE1 7EH.

COPYRIGHT 1998 British Medical Association
COPYRIGHT 2000 Gale Group

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