Bye Bye Propoxyphene

[southerndoc]

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The FDA decided to heed the advice of its advisory panel, which voted last year to remove propoxyphene (Darvon, Darvocet) from the market.

About time... the drug has a high abuse potential, doesn't treat pain well, and is prone to side effects (especially in the elderly who often have reduced renal function).

http://www.cnn.com/2010/HEALTH/11/19/fda.removes.drug/index.html?hpt=T2

 

[1UP]

I know a bunch of patients that swore by propoxyphene for OA pain after failing high dose acetominophen, tramadol, and are already taking piroxicam, etc... for inflammatory control.

What's a decent alternative for these patients?

Tonight (yes, I have no life) I went through the monographs for just about every reasonable alternative analgesic and I honestly couldn't find anything that 1) Didn't have more side effects 2) Wasn't more addictive 3) Both 1 & 2.

I just know the phone is going to be ringing off the hook on Monday, I'd like to at least be able to offer these people at least one reasonable alternative to mull over.

 

[BADMD]

I know a bunch of patients that swore by propoxyphene for OA pain after failing high dose acetominophen, tramadol, and are already taking piroxicam, etc... for inflammatory control.

What's a decent alternative for these patients?

Tonight (yes, I have no life) I went through the monographs for just about every reasonable alternative analgesic and I honestly couldn't find anything that 1) Didn't have more side effects 2) Wasn't more addictive 3) Both 1 & 2.

I just know the phone is going to be ringing off the hook on Monday, I'd like to at least be able to offer these people at least one reasonable alternative to mull over.

Why not just use a plain old opiate, instead of a synthetic one. The analgesia is probably better and the dependence/abuse potential is about the same.

 

[xaelia]

Nucynta.

(yessssss)

 

[VA Hopeful Dr]

I know a bunch of patients that swore by propoxyphene for OA pain after failing high dose acetominophen, tramadol, and are already taking piroxicam, etc... for inflammatory control.

What's a decent alternative for these patients?

Tonight (yes, I have no life) I went through the monographs for just about every reasonable alternative analgesic and I honestly couldn't find anything that 1) Didn't have more side effects 2) Wasn't more addictive 3) Both 1 & 2.

I just know the phone is going to be ringing off the hook on Monday, I'd like to at least be able to offer these people at least one reasonable alternative to mull over.

Ice/heat, injection, motrin (HD for initial pain control), joint replacement, strengthening exercises, lidocaine patch, capsaicin, PT.

 

[Ceez]

Can we ban dilaudid? It would make my job a lot easier.

 

[1UP]

Nucynta.

(yessssss)

I've heard nausea is problematic with Nycynta. Is this true? I don't know anyone that uses it regularly in practice so my knowledge with regard to this med. is rather limited.

...lidocaine patch...

Really? How does the data look on this?

 

[deuist]

Really? How does the data look on this?

I did a PubMed search and found that it helps somewhat.

 

[Pharmavixen]

Data on the lidocaine patch isn't fabulous, but worth a shot - where I work, topicals have helped reduce dosages of NSAIDs, etc.

For OA, there's also glucosamine. The data on that are conflicting, and it takes months to reach its full effect, but it's safe, and a few of our OA pts swear by it.

There's also intra-articular steroid injections.

And yeah; give opioids if warranted. For LT pain relief, they're safer than NSAIDs. I'd recommend avoiding Oxycontin for obvious reasons - go for MS Contin, or the Duragesic patches instead.

 

[Hamhock]

For OA, there's also glucosamine. .

Glucosamine? Really?

Please tell me you are not actually recommending that.

HH

 

[dchristismi]

Glucosamine? Really?

Please tell me you are not actually recommending that.

HH

My mom swore by it until it bumped her LFTs and she had to stop taking it. My ortho guys say it's worth a try. Maybe it's placebo, maybe it's something else. But it can't be any worse than darvocet.

 

[Pharmavixen]

Glucosamine? Really?

Please tell me you are not actually recommending that.

HH

What dchristismi said. Also, the OP is looking for alternatives for OA tx. Since we don't have disease-modifying agents for OA (yet), it's 100% symptom relief. If the pt finds that glucosamine does something (placebo effect, probably), and it helps keep them off or reduce the use of LT NSAIDs or opioids, then it's all good.

 

[leviathan]

Glucosamine? Really?

Please tell me you are not actually recommending that.

HH

Also agree. Until something comes out that is actually proven to work, glucosamine is fine to recommend even if it is only a placebo effect.

 

[VA Hopeful Dr]

And yeah; give opioids if warranted. For LT pain relief, they're safer than NSAIDs. I'd recommend avoiding Oxycontin for obvious reasons - go for MS Contin, or the Duragesic patches instead.

Good Lord no. I have enough trouble with my patients wanting me to increase their vicodin, I can't see morphine being any better.

I haven't yet given anyone duragesic, and I think it would likely have to be for something fairly serious (horrific RA/lupus or cancer type picture).