Published: June 2010

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Dextropropoxyphene withdrawal on 1 August 2010 - a reminder

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Prescriber Update 31(2): 11
June 2010

Healthcare professionals are reminded that the consent to distribute dextropropoxyphene containing medicines (Capadex and Paradex) will be revoked on 1 August 2010. From this date it will no longer be legal to sell, distribute or advertise these medicines unless exempted under the Medicines Act 1981.¹

This decision follows a review by the Medicines Adverse Reactions Committee (MARC), which concluded that the risks of these medicines outweigh their benefits.²

Medsafe advises prescribers not to start any new patients on Capadex or Paradex. Patients currently taking these medicines should be reviewed at the earliest opportunity.

The Best Practice Advocacy Centre (bpac^NZ) has recently issued the following advice for transferring patients from dextropropoxyphene³.

Most patients can be transferred to full doses of paracetamol alone. If pain relief is not sufficient, the next step is to add a weak opioid such as codeine (or use a combined paracetamol/codeine preparation). Alternatively, codeine alone could be trialed.

Oxycodone should not be prescribed in place of dextropropoxyphene unless there has been an inadequate response to a weak opioid. Oxycodone is a strong opioid and is only indicated as an alternative to morphine on step three on the WHO analgesic ladder.

As dextropropoxyphene is a weak opioid it is possible that some patients may experience a withdrawal reaction upon abruptly stopping treatment. Should a patient experience a severe withdrawal reaction advice may be sought from a local alcohol and drug dependency service. Further advice about transferring patients from dextropropoxyphene is planned in the next edition of Best Practice Journal.

From 1 August 2010 Capadex and Paradex can only be legally supplied in New Zealand under the provisions in the Medicines Act 1981 that relate to the supply of unapproved medicines (sections 25 and 29). Further information on the use of unapproved medicines in New Zealand is available from the Medsafe website at: www.medsafe.govt.nz/profs/RIss/unapp.asp

A copy of Medsafe's risk:benefit review of dextropropoxyphene and a Question and Answer document is available at: www.medsafe.govt.nz/hot/MediaContents.asp

References

1. Medsafe. DHCPL dated 26 March 2010. Available at:  www.medsafe.govt.nz/LtrtoHPCapadexandParadex.pdf (Adobe PDF File 76 KB)
2. MARC minute item for dextropropoxyphene, December 2009. Available at: www.medsafe.govt.nz/profs/adverse/Minutes140.htm#3.1
3. bpac^NZ. 2010. Dextropropoxyphene containing medicines to be withdrawn. Best Practice Journal. 26: 44.