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propoxyphene

(proe pox' i feen)

propoxyphene hydrochloride (dextropropoxyphene)


Darvon, Novo-Propoxyn (CAN)

propoxyphene napsylate
Darvocet-N, Darvon-N

Pregnancy Category C
Controlled substance C-IV

Drug class
Opioid agonist analgesic

Therapeutic actions
Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria,
sedation; the receptors mediating these effects are thought to be the same as those
mediating the effects of endogenous opioids (enkephalins, endorphins)

Indications
• Relief of mild to moderate pain

Contraindications and cautions


• Contraindicated with hypersensitivity to opioids, pregnancy (neonatal withdrawal
has occurred; neonatal safety not established), labor or delivery (especially when
delivery of a premature infant is expected; opioids given to mother can cause
respiratory depression of neonate; may prolong labor), lactation, suicidal or
addiction-prone patients.
• Use cautiously with renal or hepatic dysfunction, emotional depression, excessive
alcohol use; use of antianxiety, antidepressant drugs.

Available forms
Capsules—65 mg; tablets—100 mg

Dosages
ADULTS
propoxyphene hydrochloride
65 mg PO q 4 hr as needed. Do not exceed 390 mg/day.
propoxyphene napsylate
100 mg PO q 4 hr as needed. Do not exceed 600 mg/day.
PEDIATRIC PATIENTS
Not recommended.
GERIATRIC PATIENTS OR ADULTS WITH HEPATIC OR RENAL IMPAIRMENT
Use caution; reduced dosage may be necessary.
Pharmacokinetics
Route Onset Peak
Oral 30–60 min 2–2.5 hr

Metabolism: Hepatic; T1/2: 6–12 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Dizziness, sedation, light-headedness, headache, weakness, euphoria,
dysphoria, minor visual disturbances
• Dermatologic: Rashes
• GI: Nausea, vomiting, constipation, abdominal pain, liver dysfunction
• Other: Tolerance and dependence, psychological dependence

Interactions
Drug-drug
• Increased likelihood of respiratory depression, hypotension, profound sedation, or
coma with barbiturate general anesthetics
• Increased serum levels and toxicity of carbamazepine
• Decreased absorption and serum levels with charcoal

Nursing considerations
Assessment
• History: Hypersensitivity to opioids, pregnancy, lactation, renal or hepatic
dysfunction, emotional depression
• Physical: Skin color, texture, lesions; orientation, reflexes, affect; bowel sounds,
normal output; liver, kidney function tests

Interventions
• Administer to lactating women 4–6 hr before the next feeding to minimize the
amount in milk.
• Limit amount of drug dispensed to depressed, emotionally labile, or potentially
suicidal patients; propoxyphene intake alone or with other CNS depressants has
been associated with deaths.
• Keep opioid antagonist and facilities for assisted or controlled respiration on
standby in case respiratory depression occurs.
• Give drug with milk or food if GI upset occurs.
• Reassure patient about addiction liability; most patients who receive opiates for
medical reasons do not develop dependence syndromes.

Teaching points
• Take drug exactly as prescribed.
• Do not take leftover medication for other disorders, and do not let anyone else
take the prescription.
• Avoid alcohol intake while using this drug.
• These side effects may occur: Nausea, loss of appetite (take drug with food, eat
frequent small meals); constipation (request laxative); dizziness, sedation,
drowsiness, impaired visual acuity (avoid driving or performing other tasks that
require alertness, visual acuity).
• Report severe nausea, vomiting, constipation, shortness of breath or difficulty
breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.