Propoxyphene-APAP combines the opioid, propoxyphene, and an analgesic, paracetamol (acetaminophen), in a single drug, which promotes pain relief. Few countries make this drug available due to a plethora of potentially dangerous side effects. The medicine also causes benign adverse reactions, and it features warnings applying solely to paracetamol. Additionally, some other drugs or medical conditions may contraindicate its use.
Many critics of propoxyphene-APAP argue the pain relief offered by the drug is relatively weak. Also, the medication appears to foster dependence fairly easily. Discontinuation requires slow tapering to avoid symptoms of withdrawal. Another problem with the addictive nature of propoxyphene is that it may lead to taking toxic amounts of the drug. An overdose is not easy to treat, and the medication’s toxicity level has actually made it a drug of choice for assisted suicides.
It is not surprising that many countries banning the use of propoxyphene-APAP cite concerns relating to a high accidental or intentional overdose risk. People with mental health conditions may be most likely to have increased suicidal thinking as an adverse reaction to the drug. As mentioned, an overdose is frequently fatal. Other safety issues with the medication are that it may cause heart arrhythmias and heart attacks. Alternately, patients might experience seizures, respiratory depression, hallucinations, or extreme allergy.
Less serious side effects of the medication include drowsiness and dizziness. Like many other opioids, propoxyphene-APAP may upset the stomach, resulting in nausea or constipation. A few other mild adverse reactions are blurred vision, minor rash, and slight mood changes.
Other issues associated with propoxyphene-APAP concern its inclusion of paracetamol. In recent years, studies have shown that this easy to obtain analgesic can cause severe liver toxicity when taken in high amounts. For this reason, people should never take propoxyphene with other acetaminophen preparations, and the presence of liver disease or alcoholism contraindicates its use. Patients with paralytic ileus, heart rhythm conditions, and asthma or other breathing difficulties are also advised not to take this medication.
Many other drugs can negatively interact with propoxyphene-APAP. Most central nervous system depressants like benzodiazepines, opioids, and barbiturates can intensify the side effects of the drug. An older class of antidepressants, monoamine oxidase inhibitors (MAOIs), is generally not recommended in conjunction with the drug. Certain anti-seizure meds that are also used in the treatment of bipolar disorder, such as carbamazepine, may result in potentially risky side effects. To prevent other interactions, patients should tell their doctors about all drugs used before accepting a prescription for propoxyphene.
