Narcotic analgesic 

Constipation,abdominal pain,skin rashes, lightheadedness, headache, weakness, euphoria, dysphoria, minor visual disturbances, abnormal liver function, reversible jaundice

Hypersensitivity to propoxyphene

Special precautions:

May impair mental or physical abilities required to perform potentially hazardous tasks. Observe caution while driving or tasks requiring mental alertness.

Narcotic analgesic

Dosage:

Usual dose: 65mg every 4 hours as needed.

Do not exceed 390mg per day. In hepatic and renal impairment,consider reducing total daily dose.

For Availability/supplies 

CENTRAL NERVOUS SYSTEM DISORDERS / AND OR ADVERSE REACTIONS- NOTES

 ( Ref- Harrisons - Priniciples of Internal Medicine Ninth Edition )

1. Sleep Apnea ( 1274 )

2. Cerebellar ataxia ( 92 )

3. Stupor ( 115 )

4.Coma ( 115 )

5. Hypesthesia ( 112 )

6. Confusion ( 122 )

1. Sleep Apnea ( 1274 )

 Number of patients have been described in whom breathing periodically stops during sleep as a result of upper airway obstruction. Airway obstruction can be caused by backward movement of the tongue, collapse of pharyngeal walls , or greatly enlarged tonsils or adenoids. Loud snoring is a feature and the patient may wake violently after an apneic episode. There is often sleep deprivation, and the patient may ehibit daytime somnolence

2. Cerebellar ataxia ( 92 )

 Intention tremor, irregular slowness in starting and starting and stopping alternating voluntary movements

3. Stupor ( 115 )

 In stupor mental and physical activity are reduced to a minimum. Although inacessible to many stimuli, the patient opens the , looks at the examiner, and does not appear to be unconscoius. Response to soken commands is either absent or slow and monosyllabic

4.Coma ( 115 )

 The patient appears to be asleep and is at the same time incapable of sensing ( unreceptive ) and rersponding adequately to either external stimuli or inner needs ( unresponsive ) is in a state of coma

5. Hypesthesia ( 112 )

 The term hyperesthesia - It implies a heightened receptiveness of the nervous system, careful testing will usually demontrate an underlying sensory defect, or thermal stimuli, once the stimuli is perceived, however, it may have a severely painful or unpleasant quality (hyperpathia )

6. Confusion ( 122 )

 Confusion is a general term denoting an incapacity of the patient to think with with customary speed and clarity. This abnormality may depend on any one of several factors. Confusion is related to a dearrangement of intelluctual functions ie. an ability to,leran, remember, calculate make appriopiate deductions from given premises, reason abstractly etc.

 1. May cause drowsiness,dizziness,or blurring of vision;use caution while driving or performing other tasks requiring alertness.

2.Avoid alcohol or other sedative or drowsiness-causing drugs

3.May cause nausea,vomiting or constipation; notify physician if these symptoms occur.

4. Can be taken with food,if GI upsets occur.

5. Notify physician,if shortness of breath or difficulty is faced.

6. Allergy- Tell your doctor if you had any unusul reaction to any narcotic analgesics , and also to food substances, presrvatives, or dyestuffs.

7. Pregnancy- Studies on birth defects with narcotics have not been done in pregnant women. These medicines not reported to cause any birth defects. Hydrocodone, hydromorphone and morphine caused birth defects in animals when given in large doses. Buptophanol, nalbutaphine, pentozocine, cause birth defects in animals. There is no information about whether other narcotic analgesics cause birth defects in animals.

8. Breast feeding- Most narcotic analgesics have not been reported to cause problems in nursing babies.However when large amounts of methadone is take by the mother, the nursing baby may become dependent on the medicine.

9. Children- Breathing problems likely to occur in children younger than 2 years of age, as they are more sensitive than adults to the effects of narcotic analgesics.

10. Older adults- Elderly people are more sensitive to the effects of narcotic analgesics.This may increase the chance of side effects, especially breathing problems, during treatment.

11. Other medicines- Tell your doctor if are taking any of the following- Carbamazepine - propoxyphene may increase blood levels of carbamazepine which increases the chance of serious side effects.

Central nervous system depresants or MAO inhibitors taken currently or within the past 2 weeks or Tricyclic antidepressants - chance of side efects increased, combination of mepridine and MAOI is especially dangerous

Naltrexone - narcotics will not be effectve in people taking naltrexone

Rifampicin - decreass efects of methadone and cause withdrawal symptoms in people who are dependent on methadone

Zidovudine- Morphine may increase blood levels of zidovudine and increase chance of serious side effects.

12. Other medical problems- Tell your doctor if you have other medical problems such as- Alcohol abuse or Drug dependence especially narcotic abuse or Emotional problems -chance of sideeffects maybe increased ,also withdrwal symptoms mau occur if a narcotic you are depedent or is replaced by buphrenorphine ,butophanol, nabuphine or pentozocine.

Brain disease or head injury or Empysema , astma oroter chronic lung disease or Enlarged prostrate orproblems withurination or Gall bladder disease or gall stones -someof side effects of narcotic nalgesics can be dangerous if these conditions are present.

Colitis or Heart disease or Kidney disease or Liver disease or Underactive thyroid - chance of side effects may be increased

Convulsions - some of the narcotic analgesics can cause convulsions

13. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

14. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

15. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

Pharmacology:

Propoxyphene is a centrally acting narcotic analgesic structurally related to methadone; its analgesic resides in dextrororatory isomer. Proxpoxyphene is 1/2 to 2/3 as potent as codeine.

Pharmacokinetics:

Water soluble hcl (Hcl) salt is absorbed more readily than relatively water insoluble napsylate salt.. Peak plasma concentrations for the hcl are acheived in 2 to 2.5 hours Proxyphene is metabolised in the liver with a half-life of 6 to 12 hours, and the major metabolite norpropoxyphene,has a half-life of 30 to 36 hours.

Not significant

Pregnancy:

Safety for use during pregnancy is not established. Use only if needed

. Lactation:

Low levels have been detected in breast milk. No adverse effects have been noted in nursing infants.