1. Use of dextropropoxyphene + acetaminophen fixed-dose combination in psychiatric hospital in Bahrain: is there a cause for concern?
- Author
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Al Khaja KA, Al-Haddad MK, Al-Offi AR, Abdulraheem MH, and Sequeira RP
- Subjects
- Acetaminophen administration & dosage, Acetaminophen adverse effects, Adolescent, Adult, Analgesics, Non-Narcotic administration & dosage, Analgesics, Non-Narcotic adverse effects, Analgesics, Opioid administration & dosage, Analgesics, Opioid adverse effects, Bahrain, Dextropropoxyphene administration & dosage, Dextropropoxyphene adverse effects, Drug Combinations, Drug Interactions, Female, Hospitals, Psychiatric, Humans, Male, Practice Patterns, Physicians' standards, Psychotropic Drugs adverse effects, Psychotropic Drugs therapeutic use, Retrospective Studies, Substance-Related Disorders rehabilitation, Young Adult, Acetaminophen therapeutic use, Analgesics, Non-Narcotic therapeutic use, Analgesics, Opioid therapeutic use, Dextropropoxyphene therapeutic use
- Abstract
There are concerns about the safety of the dextropropoxyphene and acetaminophen fixed-dose combination, particularly in patients with psychiatric morbidity, which has led to a phased withdrawal of this fixed-dose combination in many countries. A retrospective prescription audit was conducted to evaluate the dextropropoxyphene + acetaminophen fixed-dose combination prescribing pattern in the major psychiatric hospital of Bahrain. The data analysis was performed using SPSS/PC+ version 14.0. Prescriptions with the dextropropoxyphene + acetaminophen fixed-dose combination comprised 11.8% of all dispensed prescriptions and in most instances for outpatients undergoing substance abuse rehabilitation. Nearly half of the patients received >or=20 tablets of this fixed-dose combination (mean +/- SD: 30.9 +/- 13.1; range 20-126) as multiple doses. The dextropropoxyphene + acetaminophen fixed-dose combination was often co-prescribed with psychotropics, such as benzodiazepines (BZDs) (25.4%), BZDs + antidepressants (62.9%), BZDs + antipsychotics (3.7%) and BZDs + anticonvulsants (1.9%). Approximately 40% of prescriptions with the dextropropoxyphene + acetaminophen fixed-dose combination were written 'as required' (prn), basis. Despite poor safety and efforts to restrict or withdraw worldwide, the dextropropoxyphene + acetaminophen fixed-dose combination continues to be irrationally prescribed to outpatients undergoing substance abuse rehabilitation in Bahrain. Health policy decision-makers should introduce a phased withdrawal of this drug from clinical use. In the meanwhile, it is important to create awareness among prescribers of the risks associated with over-dosage of the dextropropoxyphene + acetaminophen fixed-dose combination and its interaction with other psychotropic medications.
- Published
- 2009
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