Generic Name

Propoxyphene Hydrochloride

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Classification

FDA Approved Indications

• Short-term management of mild to moderate pain

Mechanism of Action

Propoxyphene acts centrally on the brain to alter the perception of and response to pain stimuli. It binds to opioid receptors, producing analgesia and sedation.

Dosage and Administration

Adult: Initially 65 mg every 4 hours as needed; maximum 390 mg per day.

Pediatric: Not recommended for pediatric use.

Geriatric: Use with caution; consider lower doses due to increased sensitivity and risk of adverse effects.

Renal Impairment: Adjust dose as needed; monitor closely.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver via conjugation and other pathways.

Excretion: Excreted primarily in urine.

Half Life: Approximately 2-4 hours.

Contraindications

• Hypersensitivity to propoxyphene or any component of the formulation.
• Use in patients with respiratory depression, severe hepatic or renal impairment.
• Use concomitantly with monoamine oxidase inhibitors (MAOIs).

Precautions

• Use with caution in elderly, in cases of respiratory depression, head injury, or increased intracranial pressure. Prolonged use may lead to dependence.

Adverse Reactions - Common

• Dizziness (Common)
• Drowsiness (Common)
• Nausea (Common)

Adverse Reactions - Serious

• Respiratory depression (Serious, less common)
• Hepatic impairment (Serious, rare)
• Allergic reactions including rash (Serious, rare)

Drug-Drug Interactions

• Additive CNS depression with sedatives, hypnotics, tranquilizers, other opioids.
• Increased risk of serotonin syndrome with serotonergic drugs.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Do not operate machinery or drive until response to medication is known.
• Report any signs of respiratory depression, rash, or allergic reactions.
• Avoid alcohol and other CNS depressants.
• Take medication exactly as prescribed.

Special Considerations

Black Box Warnings:

• Propoxyphene has a risk of cardiac arrhythmias and death, especially at high doses or with chronic use.
• It is also associated with dependency.

Genetic Factors: Genetic variations can affect metabolism, potentially influencing efficacy and toxicity.

Lab Test Interference: May interfere with certain hepatic or renal function tests.

Overdose Management

Signs/Symptoms: Respiratory depression, pinpoint pupils, unconsciousness.

Treatment: Supportive care, airway management, naloxone administration if respiratory depression occurs.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions.