ECG Abnormalities in Co-proxamol (Paracetamol/Dextropropoxyphene) Poisoning

Abstract

QRS is significantly prolonged in co-proxamol overdose, and this prolongation is dose dependent. These findings have clinical relevance to the management of patients with co-proxamol poisoning.

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“…Consistently, the combination of co-proxamol was shown to be 10 times more likely to cause death for every million prescriptions issued than the other compound paracetamolopioid preparations with codeine and dihydrocodeine that are widely used in the UK [1,2]. Similarly, episodes of poisoning notified to the UK National Poisons Information Service were in proportion to prescription numbers, confirming that the differences in mortality were indeed related to excess toxicity rather than disproportionate use in overdose [1,3].…”

“…Cases with respiratory depression or SNC depression require admission to an intensive care unit [74]. Dystonia, seizures or seizure-like activities have also been reported [3,75].…”

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“…This property is usually associated with sodium channel blockade and is a precursor to ventricular arrhythmia. We have shown a significant relation between estimated dextropropoxyphene dose (based on paracetamol concentration) and QRS prolongation in a case of co-proxamol poisoning,4 an effect not seen with other opioid combination products.…”

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“…This action is separate from the opioid antagonist action associated with dextropropoxyphene. We have also shown a relationship between length of QRS and ingested dose, as reflected by plasma paracetamol concentration, 3 further emphasising the dose dependency of this change. The hypothesis advanced as a result of these findings is that dextropropoxypheneassociated death is secondary to a complication of the opioid and electrophysiological actions.…”

“…By examining electrocardiogram (ECG) changes in a cohort of 15 patients poisoned with coproxamol and comparing them with 15 cases who ingested other opioid-paracetamol combination products, we have shown that © 2005 Blackwell Publishing Asia Pty Ltd co-proxamol ingestion is associated with widening of the QRS complex on the ECG. 3 This phenomenon is usually attributed to sodium channel blockade and, as such, if sufficiently wide, is a risk factor for cardiac arrhythmia. This action is separate from the opioid antagonist action associated with dextropropoxyphene.…”