Dar·von (där v n) A trademark for the drug propoxyphene hydrochloride. |
Darvon,
Darvon,
propoxyphene hydrochloride Warning - High-alert drug!
Darvon
Pharmacologic class: Opioid-like agonist
Therapeutic class: Nonopioid analgesic
Controlled substance schedule IV
Pregnancy risk category C
FDA Boxed Warning
• Don't administer to patients who are suicidal or addiction-prone.
• Give cautiously to patients who take tranquilizers or antidepressants or who use alcohol in excess.
• Advise patient not to exceed recommended dosage and to limit alcohol intake during therapy.
• When used in excessive dosages (alone or in combination with alcohol or other CNS depressants), propoxyphene products are a major cause of drug-related deaths. Deaths may arise within first hour of overdose; many have occurred in patients with history of emotional disturbances or suicidal ideation or attempts or history of misuse of tranquilizers, alcohol, and other CNS drugs.
Action
Alters perception of and emotional response to pain by binding with opiate receptors in brain, causing CNS depression
Availability
propoxyphene hydrochloride
Capsules: 65 mg
propoxyphene napsylate
Tablets: 100 mg
⊘Indications and dosages
➣ Mild to moderate pain
Adults: 65 mg (hydrochloride) P.O. q 4 hours or 100 mg (napsylate) P.O. q 4 hours as needed. Don't exceed 390 mg/day hydrochloride or 600 mg/day napsylate.
Dosage adjustment
• Hepatic or renal impairment
• Elderly or debilitated patients
Contraindications
• Hypersensitivity to drug or its components
• Suicidal or substance abuse-prone patients
Precautions
Use cautiously in:
• head trauma; increased intracranial pressure; severe renal, hepatic, or pulmonary disease; hypothyroidism; adre-nal insufficiency; prostatic hypertrophy; undiagnosed abdominal pain; alcoholism
• patients receiving MAO inhibitors
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children.
Administration
• Give with milk or food to reduce GI upset.
• Be aware that 100 mg propoxyphene napsylate is equivalent to 65 mg propoxyphene hydrochloride.
| Route | Onset | Peak | Duration |
| P.O. | 15-60 min | 2-3 hr | 4-6 hr |
Adverse reactions
CNS: dizziness, headache, dysphoria, euphoria, insomnia, paradoxical excitement, asthenia, sedation
CV: hypotension
EENT: blurred vision
GI: nausea, vomiting, constipation, abdominal pain
Skin: rash
Other: physical or psychological drug dependence, drug tolerance
Interactions
Drug-drug. Antidepressants, sedative-hypnotics: additive CNS depression
Buprenorphine, dezocine, nalbuphine, pentazocine: decreased analgesic effect
MAO inhibitors: unpredictable and potentially fatal effects
Partial-antagonist opioid analgesics: precipitation of withdrawal in physically dependent patients
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase: altered levels
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
Smoking: increased metabolism and decreased analgesic efficacy of propoxyphene
Patient monitoring
• Assess patient's pain level 30 minutes after giving drug.
• Evaluate CNS effects. As needed, institute measures to prevent injury.
• In long-term therapy, monitor liver function tests and evaluate patient regularly for signs of physical or psychological drug dependence.
Patient teaching
• Advise patient to take with milk or food to minimize GI upset.
• Inform patient that drug may cause physical or psychological dependence. Stress that he should take it only when needed and only as prescribed.
• Tell patient that alcohol use and smoking affect drug blood level. Discourage these habits.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
Darvon®
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