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Dextropropoxyphene or Darvon

Dextropropoxyphene (brandnamed Darvon) was a popular narcotic which is used less these days since it no longer is covered by patent, so no company is out promoting it for the big profits.  No free lunches to doctors.  No free pens, elegant dinners, visits from attractive sales reps.  Of course, like all narcotics, it is a weak pain reliever.  The combination of dextropropoxyphene with acetaminophen (Darvocet) was much more popular due to its greater pain relieving ability.

In double-blind studies, many different pain relievers were better than propoxyphene or propoxyphene/acetaminophen in 15 study.  These better pain relievers include: diclofenac, naproxen, floctafenine, suprofen (2), indoprofen, ibuprofen (3), mefenamic acid, nefopam, zomepirac, diflunisal, ketorolac, and fluproquazone.  Non-narcotics were equally effective against pain with fewer side-effects in three studies. In two studies, the combination of propoxyphene/acetaminophen did equally well and in two studies, propoxyphene by itself did equally well.  Those latter two studies were doing the equal of caffeine when added to acetaminophen and being the equal of ergotamine for preventing headaches.  Neither of those is much of an accomplishment.  In every other study in which propoxyphene did equally well to a pain reliever, that pain reliever did better than propoxyphene in another study, strongly suggesting that propoxyphene is inferior.  

Dextropropoxyphene's record is 0 wins, 18 losses, and 4 ties with two of the ties primarily due to the added acetaminophen and the others against very weak pain relievers.  Dextropropoxyphene is a real loser.  It should be taken off the market, since the harm it causes through addiction vastly outweighs any benefit to society.

If a doctor gives you Darvon or propoxyphene, print out this webpage and give it to him.  If he still insists on giving you a narcotic, get another doctor.  If a doctor gave you Darvon or propoxyphene and you became addicted and suffered some unfortunate consequence, the doctor and the narcotic manufacturer could be liable for malpractice.  Also, consider whether you should report the doctor to the state licensing board.  In view of the research, prescribing propoxyphene is or at least should be ruled malpractice.

Propoxyphene with acetaminophen (Darvocet) is being withdrawn from the British market (Prescrire Int 2005 Aug;14:145.).

Arthritis: Diclofenac Better than Dextropropoxyphene with Acetaminophen: In a DB study of 846 pains with hip, knee, ankle, and/or wrist pain, diclofenac-SR 100 mg daily reduced pain 8% better than dextropropoxyphene 180 mg with acetaminophen 1950 mg/day (p<0.05). Diclofenac resulted in less time lost from work (p<0.05). Dextropropoxphene patients suffered more tiredness, sleep disturbance (50 vs. 21, p<0.01) while diclofenac had more abdominal or epigastric pain or indigestion (40 vs. 18, p<0.01). Parr G, et al. Br J Clin Pharmacol 1989;27(2):235-42.

Arthritis: Suprofen as Effective as Propoxyphene with More Propoxyphene Dropouts: In a DB study of 114 patients with osteoarthritis, suprofen 200 mg q.i.d. did as well as propoxyphene 65 mg q.i.d. at relieving pain. Of suprofen patients, 24% discontinued therapy vs. 34% of propoxyphene primarily due to GI complaints. Salzman RT, et al. Pharmacology 1983;27 Suppl 1:55-64.

Arthritis: Caffeine as Good as Propoxyphene: In a 7-day DB French study of 124 adults, mostly with lower back pain, 51% of those with the caffeine vs. 47% of those with the dextropropoxyphene had a major reduction (>50%) in pain. Kuntz D, et al. Paris. Analgesic effect and clinical tolerability of the combination of paracetamol 500 mg and caffeine 50 mg vs. paracetamol and dextropropoxyphene. Presse Med 1996;25(25):1171-4. 

Arthroscopy: Naproxen Relieved Pain Better than Propoxyphene with Acetaminophen: In a 6-hour DB study of 52 patients undergoing arthroscopy, initially moderate (55/100 on VAS scale) post-op pain was less at each hourly interval with naproxen, especially at the 1 hour mark (p=.008). Seven of the propoxyphene patients requested additional pain medication vs. one of the naproxen. Drez D Jr., et al. South Med J 1987 Apr;80(4):440-3.

Cholescystectomy Post-Op Pain: NSAID Floctafenine Better than Propoxyphene But Not as Effective as Meperidine: In a DB crossover study of 40 patients, the non-narcotic floctafenine 200 mg did not do as well as meperidine 75 mg but did better than propoxyphene 65 mg. However, side-effects were fewest after floctafenine. Morris ME, et al. Clin Pharmacol Ther 1978;23:383-9.

Dental Extraction: Suprofen More Effective than Codeine or Propoxyphene and More Effective than Codeine with Aspirin: In 2 DB studies totalling 224 patients having periodontal surgery and removal of impacted 3rd molars, suprofen 200 mg was significantly more effective than codeine 60 mg or propoxyphene 65 or aspirin 650 mg. Suprofen 400 mg was also significantly more effective that the codeine-aspirin combination. Cooper SA, et al. Pharmacotherapy 1986;6:267-76.

Dental Extraction: Suprofen Better Pain Relief than Narcotic Dextropropoxyphene/Acetaminophen:  In a DB study of 57 patients, suprofen provided better pain relief than dextropropoxyphene 65 mg with acetaminophen 650 mg when taken up to four times daily for 3 days (p=0.01) with better second night's sleep (p=0.01). Six had side-effects on suprofen vs. 10 on dextropropoxyphene. Rosen M, et al. Anesthesia 1985;40:639-41.

Dental Surgery: NSAID Indoprofen Better than Codeine/Acetaminophen or Propoxyphene/Acetaminophen: In a DB study of postsurgical dental patients, indoprofen 200 mg was better than acetaminophen 650 mg/codeine 60 mg and better than acetaminophen 650 mg/d-propoxyphene N. The narcotic combinations were slightly better than plain acetaminophen, which was better than placebo. Cooper SA, et al. J Oral Surg 1981;39:21-5.

Dental Surgery Pain: Ibuprofen More Effective for Degree and Duration of Pain vs. Propoxyphene or ASA: In a DB PC study of ibuprofen 400 mg and 800 mg, both doses did better at relieving pain during the 3 hour study than aspirin 650 mg or propoxyphene 65 mg. Winter L Jr., et al. Surg Oral Med Oral Pathol 1978;45:159-66.

Dysmenorrhea: Ibuprofen Better Pain Relief than Narcotic Propoxyphene: In a DB crossover study of 55 women with painful periods over 3 successive cycles, ibuprofen 400 mg was clearly superior to propoxyphene 64 mg or placebo. It gave better relief, had higher patient satisfaction, and less need for additional pain medications with significantly more women able to continue their normal daily functions. Morrison JC, et al. South Med J 1980;73:999-1002.

Dysmenorrhea: Ibuprofen Much More Effective than Propoxyphene: :In a DB crossover study of just 22 patients with severe primary dysmenorrhea, ibuprofen was much more effects a relieving pain (p<0.001). Propoxyphene was somewhat more effective than placebo (p<0.05). Larkin RM, et al. Obstet Gynecol 1979;54:456-60.

Dysmenorrhea: NSAID Mefenamic Acid Better than Propoxyphene/Acetaminophen for Pain and Nausea: In a DB crossover study of 30 women, mefenamic acid 250 mg did significantly better than dextropropoxyphene 32.5/acetaminophen 325 mg. for both pain as well as faintness, nausea, and constipation. Anderson AB, et al. Lancet 1978;1(8060):345-8.

Episiotomy Pain: NSAID Nefopam Provided Better Pain Relief than Narcotic Propoxyphene: In a DB PC study of 100 postpartum women with moderate to severe pain, nefopan 45 mg and nefopam 90 mg both resulted in significantly better pain reduction: greater than 50% reduction: nefopam 45 mg 84%, nefopam 90 mg 80%, propoxyphene 65 mg 72%, and placebo 44%.  Bloomfield SS, et al. Clin Pharmacol Ther 1980;27:502-7.

Episiotomy Pain: Neither Diflunisal Nor Propoxyphene/Acetaminophen Helped: In a DB study of 57 women, neither diflunisal 500 mg twice daily nor dextropropoxyphene 65 mg/acetaminophen 650 mg 3 times a day did any better relieving pain over the 2 day study than placebo for pain relief by patient report. Buck ME, et al. Curr Med Res Opin 1978;5:548-9.

Headaches: Migraines: Ergotamine Equal to Dextropropoxyphene at Preventing: In a DB crossover study of 25 patients with 525 acute migraines, ergotamine was equally effective as preventing migraines compared to dextropropoxyphene and both were better than aspirin. Patient preference did not differ between ergotamine and propoxyphene. Hakkarainen H, et al. J Clin Pharmacol 1980;20:590-5.

Hemorrhoid Surgery: Post-Op Pain: NSAID Diflunisal Better than Narcotic Dextropropoxyphene: In a DB study of 43 patients having excision of hemorrhoids under spinal anesthesia, 25% of patients had no significant pain and did not need any medication. Of the remaining 32, 41% of diflunisal vs. 60% of dextropropoxyphene patients needed additional pain meds. Diflunisal maintained its advantage on the day after surgery, although neither group needed additional meds. Jalovaara P, et al. Ann Chir Gynecol 1985;74:228-32.

Hysterectomy Post-Op Pain: NSAID Fluproquazone Better than Narcotic Propoxyphene/Acetaminophen: In a DB study of post-hysterectomy patients, fluproquazone 200 mg relieved pain better both with the first dose and over the first 24 hours vs. propoxyphene 65 mg/aceminophen 500 mg or placebo. Side-effects were equally well tolerated. Frerich D, et al. Arzneimittleforschung 1981;31:925-7.

Orthopedic Post-Op Pain: Ketorolac as Good as Dextroproxyphene Combination with Fewer Side-Effects: In a DB study of 115 patients undergoing orthopedic surgery, ketorolac 10 mg did as well as dextropropoxyphene 150 mg with aspirin 350 mg and phenazone 150 mg. There were more side-effects with the dextropropoxyphene. Johansson S, et al. Gavle Hospital, Sweden. J Int Med Res 1989 Jul-Aug;17(4):324-32.

Orthopedic Surgery Post-Op Pain: Zomepirac Better than Narcotic Propoxyphene/Acetaminophen: In a DB PC study of 196 patients, zomepirac 100 mg was significantly more effective tha propoxyphene 100 mg with 650 mg acetaminophen or placebo. Patients requiring additional medication were: placebo 77%, propoxyphene/acetaminophen 48%, zomepirac 50 mg 43%, and zomepirac 100 mg 29%. Side-effects did not differ between med groups. Honig S, et al. J Clin Pharmacol 1981;21:443-8.

Pain in Emergency Department: NSAID Mefenamic Acid as Good as Narcotic Propoxphene/Acetaminophen with Fewer Side-Effects: In a DB study of 87 patients coming to the emergency department with various problems with acute pain, mefenamic acid did as well as dextropropoxyphene/acetaminophen with fewer side-effects. Sleet RA, et al. Curr Med Res Opin 1980;7:77-84.

Post-Injury Pain in the ER: No Difference Between Non-Narcotic Mefenamic Acid and Propoxyphene/Acetaminophen: In a DB study of 48 patients with soft-tissue injuries, mefenamic acid 250 mg did equally well as dextropropoxyphene 32.5 mg/acetaminophen 325 up to six tablets per day. Stableforth PG. Curr Med Res Opin 1977;5:189-91.

Post-Op Pain: Ketorolac Better than Ibuprofen-Acetaminophen or Dextropropoxyphene-Acetaminophen: In a DB study of 160 patients with moderate to severe post-op pain, ketorolac 10 mg. resulted in greater pain relief over the six hours than ibuprofen 400 mg with acetaminophen 325 mg or propoxyphene 65 mg with acetaminophen 325.

Sprains and Strains: Diflunisal did as Well as Propoxyphene/Acetaminophen: In a 3-day DB study of 51 patients, there was no difference in pain relief or frequency of side-effects between NSAID diflunisal 500 mg and dextropropoxyphene 65 mg/acetaminophen 650 mg 3 times a day. Jaffe GV, et al. Curr Med Res Opin 1978;5:584-8.

Thomas E. Radecki, M.D., J.D.

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