Saturday, April 25, 2009

Why I Avoid Propoxyphene

Many clinicians use propoxyphene and its variants for pain control. I never do. In fact, the agency where I work has declared itself a "propoxyphene free zone". Independent studies have shown that it is no more effective than placebo at reducing pain. Any pain relief obtained is due to the acetaminaphen in the preparation and/or placebo effect. It is not on the WHO ladder for pain control. There are places in Europe where it is banned. The fact that propoxyphene is on the Beers list of drugs to avoid in the elderly is not entirely why I don't use it, because I do use drugs on that list for elders, but in small doses and while closely monitoring their effect. The primary reason is that it is so ineffective, especially for the kind of pain that most of my patients have, and there are so many other alternatives.

When I choose a pain medication, I want something that is not too strong, but not too weak. I usually give tramadol or hydrocodone, or morphine or oxycodone in small doses. I may even start with very low doses of methadone. It depends entirely on the clinical situation: reason for pain, level of pain, age of the patient, renal and liver function. These medications have a more predictable affect and can be adjusted easily one way or the other as needed. Oxycodone and morphine have long acting preparations, and methadone itself is long acting.

So I don't use this drug. It may have some use for acute musculoskeletal pain, in young people under 40. I'll be interested in your feedback.

I'm back

Sorry to have been away from this for a few weeks. Sometimes there is more to do than time to do it in. Between work and family obligations, I've had to take a breather. I hope to be back and posting more frequently.