New NPS information on dextropropoxyphene: recommendations and alternatives

NPS has published information online for prescribers to help them prepare for the TGA’s cancellation of Capadex and Paradex, two of the four medicines available in Australia containing dextropropoxyphene. 

This information outlines recommendations for prescribers, new contraindications and alternatives to dextropropoxyphene for analgesia.

NPS CEO Dr Lynn Weekes says that the TGA cancellation reflects well-known concerns that dextropropoxyphene has an unfavourable balance of analgesic efficacy and toxicity.

“While Di-Gesic and Doloxene will remain on the market for the time being, the advice remains the same for all these medicines —the potential harms outweigh the possible benefits,” says Dr Weekes.

NPS recommends prescribers should not initiate dextropropoxyphene treatment for any new patients, they should review all patients currently taking dextropropoxyphene (Doloxene) or paracetamol with dextropropoxyphene (Capadex; Di-Gesic; Paradex), and they should inform patients taking Capadex or Paradex that their current analgesic is being withdrawn for safety reasons and they will need to change to a different treatment.

For patients currently taking Doloxene or Di-Gesic, prescribers should advise them that these may become unavailable at short notice and they should consider substituting with an alternative analgesia.  As a consequence of the TGA decision, the Department of Veterans' Affairs has withdrawn Doloxene from the Repatriation Pharmaceutical Benefits Scheme as of 1 March 2012.     

NPS also outlines some of the side effects and withdrawal reactions for GPs to be aware of, information about checks and tests, and contraindications to be aware of.

“There are alternatives to dextropropoxyphene for analgesia,” says Dr Weekes.

“Importantly, prescribers should review the patient’s analgesic requirements as the need for analgesia may have changed.”

Prescribers can also consider switching to paracetamol — there is no evidence that dextropropoxyphene in combination with paracetamol is any more effective than paracetamol alone — or if paracetamol is insufficient, a low dose NSAID (e.g. ibuprofen) may be added or used instead of paracetamol. NSAIDs should be used at the lowest possible dose for the shortest possible duration.

If NSAIDs are contraindicated consider a weak opioid (e.g. codeine) added to maximum daily dose paracetamol, but strong opioids (e.g. oxycodone) or tramadol are not recommended as first-line alternatives to dextropropoxyphene.

The information for prescribers is available at the NPS website at: http://www.nps.org.au/health_professionals/withdrawal_of_dextropropoxyphene

NPS has resources available for people who take pain relief medicines

The NPS website, www.nps.org.au, has information to help your patients learn more about being medicinewise when managing pain.

NPS also offers a Medicines List and an iPhone app which helps your patients keep track of their medicines; to find out more and to order copies of the NPS Medicines List visit www.nps.org.au/medicineslist

Note

In July 2010, the organisation previously known as the National Prescribing Service was renamed ‘NPS: Better choices, Better health’.

The new name — NPS: Better choices, Better health — reflects the variety of work done by the organisation, including research and education on quality use of medicines and medical tests.

While NPS: Better choices, Better health is our official name, most people now just refer to us as NPS.

NPS is independent, not-for-profit and evidence based, and works with health professionals, academics, policy makers, industry and consumer groups, as well as communicating directly with medicine users to bring about a medicinewise Australia.