When you're in pain, it's natural to ask for something stronger. And of course doctors want to make patients in pain more comfortable. For many seniors, the result has been that they walk out of the doctor's office with a prescription for Darvon, Darvocet, or a generic equivalent.
In fact, these painkillers, which contain the active ingredient propoxyphene, are so popular they're the 12th most prescribed generic drug in the country, with 23 million prescriptions written a year. Having been around more than 50 years, they're very popular with older adults. Yet health experts and consumer groups have for years been warning of the dangers of Darvon/Darvocet, particularly for seniors.
In 2006, The Public Citizen petitioned the FDA to ban propoxyphene medications, and on January 30th, an FDA advisory panel narrowly voted to recommend a phase-out. (In 2005, health authorities in the UK initiated a phased removal and it's almost completely off the market throughout the UK.)
Why the alarm? Propoxyphene is a central nervous system depressant, so it can cause dizziness and disorientation, and many health advocates for the elderly are concerned that these drugs greatly increase the risk of falling. In fact, propoxyphene is specifically listed as a risk factor for hip fractures!
It can also cause mental confusion that can be mistaken for dementia. Another risk is severe depression, suicidal thoughts, and death. Data from the Federal Drug Abuse Warning Network attributed 5.6 percent of all drug-related deaths to propoxyphene-based painkillers. And many of these were suicides. (When combined with alcohol, it's even more dangerous.) Then there's the fact that propxyphene can build up in the system and increase or trigger heart problems. Need I say more?
The FDA is continuing to hear testimony from experts and is expected to decide the drug's fate in the next few weeks. At the very least, it's almost certain they will add new safety warnings and possibly tighten restrictions on use.
But for caregivers, there's no time to waste. Believe me, as many of us have found out the hard way, you really don't want your parent or other family member taking this drug. So check the medicine cabinet for Darvon, Darvocet, Wygesic, or a generic propoxyphene compound. If you find it, it's time for a talk.
Of course, those taking Darvon or Darvocet may be anxious about giving it up. But the truth is, repeated studies have shown that propoxyphene is no more effective than Tylenol (acetominophen) or aspirin, despite its risks. Here are some alternatives to ask about:
- For mild pain, acetominophen -- up to 650 mg -- or aspirin is the best bet.
- For moderate to severe pain, Vicodin (hydrocodone) is usually recommended.
Discuss with the doctor whether it's necessary to gradually reduce your family member's dosage; because propoxyphene is an opiate, it's possible to become dependent on this drug, and many people who've been taking it for a long time are dependent, experts say.
No matter what the FDA does, the advisory panel's vote is good news for those trying to raise awareness about the dangers of Darvon/Darvocet. As one pharmacist commented in response to the FDA's news release: "As a pharmacist at a local hospital, I cringe every time I see an 80-something-year-old patient with Darvon/Darvocet listed among their home medications. In our hospital, we have a policy to limit the number of doses a patient can receive over 24 hours, for their own safety. Great job, FDA, on moving forward to remove a horrible drug from the market, when better alternatives exist."