Goodbye to PropoxyphenePropoxyphene, a drug used to control pain, was taken off the U.S. market in November. An estimated 10 million patients have been prescribed this drug commonly known as Darvocet N (propoxyphene and acetaminophen) or Darvon (propoxyphene).
For years, studies have demonstrated propoxyphene with acetaminophen was no more effective in treating pain than acetaminophen alone. However, propoxyphene’s adverse effects can be substantial, especially in older adults. Propoxyphene can cause constipation, abuse potential, seizures, delirium and changes in mental function. More recent findings of serious heart risks prompted the total withdrawal of propoxyphene from the U.S. market.
If you are still taking propoxyphene, it is crucial that you coordinate withdrawal of the medication with your prescriber. Suddenly stopping routine use of propoxyphene can cause withdrawal symptoms, some of them serious. Tapering off of propoxyphene may be necessary. Your prescriber and pharmacist can help determine the best tapering schedule and alternative treatment for you given your other medical conditions, your type of pain and other medications prescribed.
Propxyphene is on the Beers’ list of potentially inappropriate medications. In 1991, Dr. Mark Beers published a consensus list of medicines considered to be inappropriate for long-term care facility residents. The Beers’ criteria is now in its third revision and is used in hospital, outpatient, managed care and other settings.
The Beers’ list can be found at www.seniorcarepharmacist.com under “Potentially Inappropriate Medications for Older Persons.” Health-care providers experienced with caring for older adults should be familiar with the Beers’ list.
If you find you are receiving a medication on the list, discuss the benefit over the risk of taking the medication. The list is only a guideline to alert health-care providers and patients of the potential risk of using certain medications in older adults. For you, a drug on the Beers’ list may be the most appropriate therapy.
The Beers’ list is only one tool for assessing drug therapy in older adults. Other researchers and reports have identified drugs not on the list which can cause problems in the geriatric population. Side effects of drugs may go unrecognized in the older adult because they are nonspecific (e.g. confusion, lethargy, falls).
Frequent review of your complete medication regimen by a prescriber or pharmacist can help identify medication related problems that may otherwise be missed.
Sources: Propoxyphene Withdrawn From US Market. Allison Gandey. www.medscape.com/viewarticle/732887, www.seniorcarepharmacist.com, www.fmda.org/beers.pdf. For a copy of the Beers’ list, contact Tricia Cash, Pharm. D., Certified Geriatric Pharmacist, The PharmaCare Network, 240-529-2456, tcash@3ipc.com.