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Pharmacology of Opioids
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Structurally similar to methadone, only the dextrorotatory (R isomer) form has any analgesic activity (dextropropoxyphene). Often administered in an oral formulation in combination with paracetamol or aspirin, these preparations may be no more effective than paracetamol or aspirin alone (Schug et al, 2020). Toxicity, with hallucinations, delusions, and confusion, may occur with accumulation of the renally excreted active metabolite norpropoxyphene, particularly in the older patient or in patients with renal impairment. Cardiotoxicity has also been reported, with prolongation of the QT interval and the risk of torsades des pointes and death. In view of these significant disadvantages and risks, and limited analgesic efficacy, the use of dextropropoxyphene should be discouraged (Schug et al, 2020). It has been or is being withdrawn from the market in many countries.
Common problems in the lactating woman
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Paracetamol is the analgesic of choice in breastfeeding. The amounts that pass into breast milk are considered too small to be harmful.1 If necessary it may be given in combination with codeine (as co-codamol) or dextropropoxyphene (co-proxamol), both of which are considered compatible with breastfeeding.2 With codeine there is the possibility of constipation in the mother and a small risk of colic or constipation in the baby.2
Pharmacology of opioids
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2014
Pamela E. Macintyre, Stephan A. Schug
Structurally similar to methadone, only the dextrorotatory (R isomer) form has any analgesic activity (dextropropoxyphene). Often administered in an oral formulation in combination with paracetamol or aspirin, these preparations may be no more effective than paracetamol or aspirin alone (ANZCA and FPM, 2010). Toxicity, with hallucinations, delusions, and confusion, may occur with accumulation of the renally excreted active metabolite norpropoxyphene, particularly in the older patient or in patients with renal impairment (Barkin et al., 2006; Smith, 2011). Cardiotoxicity has also been reported, with prolongation of the QT interval and the risk of torsades des pointes and death. In view of these significant disadvantages and risks, and limited analgesic efficacy, the use of dextropropoxyphene should be discouraged (Barkin et al., 2006). It has been or is being withdrawn from the market in many countries.
The pharmacological interactions between direct-acting antivirals for the treatment of chronic hepatitis c and psychotropic drugs
Published in Expert Review of Clinical Pharmacology, 2018
Carlos Roncero, Jose Luis Villegas, Maria Martínez-Rebollar, Maria Buti
As a summary of the interactions between this combination regimen and the agents active over the nervous system, it should not be coadministered with the following drugs (see Table 3): Analgesics: dextropropoxypheneAnxiolytics: oral midazolam or triazolam.Antipsychotics: pimozide, quetiapine.Anticonvulsants: carbamazepine, eslicarbazepine, oxcarbazepine, phenobarbital, phenytoin, and primidone.Other: St John’s wort.
Comparative risk-benefit profiles of weak opioids in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials
Published in Postgraduate Medicine, 2022
Wei Li, Hongyi He, Zidan Yang, Ziying Wu, Dongxing Xie
Our findings indicated that tramadol and codeine were effective drugs for the treatment of OA, but involved considerable safety issues. Dextropropoxyphene was a relatively safe option among weak opioids but only showing limited benefits in pain relief. Dihydrocodeine exhibited a relatively good safety profile but its efficacy still warrants further investigation. Increasing the doses of tramadol may offer little added clinical benefit, but more harms.