Dextropropoxyphene Overdose

Abstract

This paper comprehensively reviews the worldwide situation regarding acute overdosage of dextropropoxyphene (propoxyphene). The changing epidemiology of this type of poisoning over the last 20 years is described with discussion of concurrent trends and, in particular, the effects of different preventive measures adopted in various countries. The clinical pharmacology of dextropropoxyphene relevant to the clinical toxic effects resulting from acute overdosage is described, and the management is detailed. In particular, the importance of early diagnosis and treatment is stressed in view of the potentially lethal complications that may suddenly occur with this poisoning. Recommendations for the correct use of the specific narcotic antagonist, naloxone, are made, together with other intensive supportive measures. As dextropropoxyphene is frequently taken together with other toxic agents, the concomitant effects of alcohol and sedative drugs are described and the treatment of paracetamol (acetaminophen) in combination with dextropropoxyphene is emphasised. The most effective preventive measures for the future are suggested, but caution is advised regarding the prescription for 'at risk' patients of alternative analgesics, which may be no safer in overdosage.

Overdose of Dologesic with a Fatal Outcome: A Case Report

“…The importance of early diagnosis and treatment has been stressed by some authors in view of the potentially lethal complications of DXP overdose. 28 In fact, it was claimed that half of the patients who arrived at medical facility in asystole could be resuscitated without sequelae. 19 This makes early and aggressive treatment of DXP poisoning particularly relevant and mandatory.…”

Fatal Accident Inquiries into 97 Deaths Over Five Years in Scottish Prison Custody: Long Elapsed Times and Recommendations

“…Sixty‐two‐year‐old JB's death together with AT's death – both on remand at HMP Edinburgh, and within three months of each other, see and above at Rule 1 – should have warranted serious adverse event notifications to the Medicines and Healthcare Products Regulatory Authority (Carson 1977; Vale, Buckley and Meredith 1984; Lawson and Northbridge 1987; Obafunwa, Busuttil and al‐Oqleh 1994). …”

“…Thus, there should be a high expectation of written determination when the death is of a prisoner under 21 years of age, or when the death is exceptional in epidemiological terms, as follows: self‐inflicted other than by hanging (rare – applied for in only 2/54 in Scotland's 1999–2003 series and 13/172 suicides by prisoners in England and Wales in 1999 and 2000) (see Safer Prisons (Shaw, Appleby and Baker 2003)), a non‐self‐inflicted death on remand (also rare), or any death in which drug toxicity is implicated (whether by prescribed or illegal drugs). Drug toxicity from prescribed medication, such as dextropropoxyphene (Carson 1977; Vale, Buckley and Meredith 1984; Lawson and Northbridge 1987; Obafunwa, Busuttil and al‐Oqleh 1994) or Prozac (Gunner, Saperia and Ashby 2005; Martinez et al 2005), has implications for the wider public health as well as for prisoners; and toxicity from illegal drugs may raise security concerns for prisons. A fifth of formal findings in the 1999–2003 series were in respect of prisoner deaths for which, in the above public health or epidemiological terms, there should have been a written determination (see ).…”