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OTC & Prescription Drugs

Propoxyphene: Darvon ®, Darvocet ®, Wygesic ®, Balacet ®, Propacet ®

Propoxyphene, commonly known as Darvon ®, is a mild narcotic painkiller. When it first came out in 1957, Darvon seemed to be the ideal solution for an old medical problem: It was thought to be stronger than aspirin, but not as potent or allergic as morphine or codeine.1 However, double blind studies found that Darvon did not work much better than over-the-counter painkillers. Even its manufacturer, Eli Lilly and Company, admitted that the standard 65 mg dose of Darvon is no more effective than two aspirin.2

Propoxyphene has been banned in the United Kingdom since 2005, and it may soon be off the market in the United States as well. Public interest groups including Ralph Nader's Common Cause have been pressuring the U.S. government for years to make Darvon, and the matter is now being evaluated in the courts.

Swedish professors Birgitta and Ulf Jonasson have been leading the international fight against Darvon by writing dissertations and articles in scientific journals about the drug's ineffectiveness and potential for addiction. They believe that Darvon kills more people annually than any other drug, and that they could prove that if every coroner had to perform blood tests after every drug-related death.3

The U.S. Drug Enforcement Agency lists Darvon as one of the country's top ten abused drugs. American doctors have written between 20 and 40 million prescriptions for the drug every year for over fifty years, adding up to an annual consumption of 100 tons.4

Darvon is much more dangerous than over-the-counter drugs such as aspirin, Advil ®, Alleve ®, and Tylenol ® . Like any other opioid, Darvon is addictive, and users build up tolerances to its effects. But doctors continue to prescribe Darvon, especially to patients in prisons, nursing homes, and to those undergoing treatments in emergency rooms.5

In the 1970s, clinics used Darvon to ease withdrawal symptoms of recovering heroin addicts, but after many of them became addicted to Darvon, the government disallowed that use.6 Currently, the drug is sometimes prescribed for restless leg syndrome and diarrhea.

Forms and Brands
Propoxyphene usually comes in capsules that are easy to recognize because they say "Darvon" or "Darvocet" and "Lilly" on them. Propoxyphene is also available on the Internet and from drug pushers as generic pills or powder. Darvon, Darvon-N, Darvocet, and Darvocet-N are registered trademarks of aaiPharma LLC.

  • Darvon 32, which contains 32 mg of propoxyphene, is a pink capsule that says "Darvon" and Lilly HO3 on it.
    •Xanodyne Pharmaceuticals makes a pink 65 mg capsule that says only "Darvon" on it.

    •Teva Pharmaceuticals makes a similar pink 65 mg pill that has "93 741" printed twice on it.
  • Darvon N 100 ® are light yellow, oval pills that say "Lilly Darvon N 100" on one side. Xanodyne Pharmaceuticals also makes 100mg tablets that are white and say "Darvon N 100" on them.
  • Darvocet, Balacet ®, Propacet ® and Wygesic ® are combinations of acetaminophen (Tylenol ® is acetaminophen) and propoxyphene.
    •Wyeth's Wygesic is a teal blue pill that says "WYETH" on it. It is 65 mg of propoxyphene and 650 mg of acetaminophen.

    • Balacet and Propacet are pink, purple, white, or bright orange oval pills with numbers printed on them.
  • Eli Lilly's Darvocet-N 100 ® pills are red capsules that say "Lilly" in script on one side, and "Darvocet 100" on the other. They contain 100 mg of propoxyphene and 650 mg of acetaminophen (Tylenol ® is acetaminophen). Darvocet-N also comes as a hard red oval pill that says "Darvocet N 100" on it.
  • Darvon Compound and Darvon Compound 65 are combinations of aspirin, caffeine and propoxyphene. Darvon Compound capsules are red and gray, and have "Darvon Comp 65" and "Lilly 3111" printed on them.
Effects and Use
Common side effects of propoxyphene are drowsiness, dizziness, nausea, sedation, constipation, euphoria or depression, constipation, lightheadedness, and headache. More serious side effects can include abdominal pain, hallucinations, skin rashes, yellow skin and eyes, and visual disturbances.7

Teens abuse Darvon to obtain an initial feeling of euphoria and well-being (a "rush") that becomes a sedated sensation that lasts from four to six hours. In order to achieve a stronger rush, Darvon users chew time-release tablets or crush capsules into a powder to snort. While a typical medical dose of Darvon is 65mg three times a day; an addict may take 250 to 400mg daily.8

Methadone addicts use Darvon to tide themselves over between hits of their drug of choice. Heroin addicts use Darvon when they try to withdraw from heroin by themselves. Some homemade detoxification regimes, include the life-threatening practice.9 of taking four or five Darvon a day along with benzodiazepines such as Valium.

Some right-to-die groups offer "Darvon Cocktails" to the terminally ill.

Street names for Darvon include pinks, footballs, pink footballs, yellow footballs, 65's and N's.

Dangers and Risks
Darvon can cause allergic reactions, addiction, and psychological dependence. Overdoses of the drug can be fatal.

Many people who abuse Darvon take it in combination with aspirin or acetaminophen - two drugs which, when taken in high doses, can cause liver damage and stomach ulcers.

Signs of Use
The majority of teens who use Darvon abuse it in combination with alcohol and other drugs, often stimulants or stronger opiates such as OxyContin. Some teens use it to moderate their heroin habits.

Darvon depresses the central nervous system, so teens who are using it may appear "dopey," in a stupor, or even intoxicated. They may get into traffic accidents because their coordination is off. They may slur their words or stagger when they walk. The drug affects their moods, so when it wears off, they may become hostile, angry and aggressive. Darvon abusers will experience volatile "ups and downs" and major personality changes, will often stop taking care of their physical appearance, and may gain or lose weight.

Teens who take Darvon experience mental cloudiness, so they will not be able to concentrate on their schoolwork. They often drop their old friends in favor of new ones who use drugs. They can become secretive and hostile, spending long hours behind locked doors or at friends' houses. They may get into trouble with the law for possession or selling drugs, or a teacher may tell you that your child came to school "high."

You may find pills and drug equipment such as butane lighters in your children's rooms. They may receive packages from online pharmacies.

Teens on drugs need money, so they often steal from their parents or run up family credit cards. They may sell household items to raise money for their habits.

Overdose and Allergic Reactions
The vast majority of Darvon deaths involve a combination of Darvon and benzodiazepines such Lithium, often with alcohol. It can take less than 30 minutes to die from a Darvon overdose.

Darvon has a very narrow margin of therapeutic to toxic levels:

  • At four times the standard dose, Darvon can slow the heart and breathing to dangerous levels.
  • At six times the standard dose, users experience toxic psychosis and seizures.
  • Because Darvon addicts build up a tolerance to this drug they have to keep taking bigger doses to achieve the same effect - and each dosage increase brings them closer to lethal levels.10
According to Physicians Desk Reference, Darvon overdose symptoms can include a bluish tinge to the skin, coma, convulsions, decreased or difficult breathing (to the point of temporary stoppage), decreased heart function, extreme sleepiness, irregular heartbeat, low blood pressure, pinpoint pupils, and stupor.11
  • If an individual has been taking Darvon in combination with propoxyphene and acetaminophen, he may experience abdominal pain, excessive sweating, a general feeling of illness, kidney failure, liver problems, loss of appetite, nausea, and vomiting.
  • If she has been taking a combination of propoxyphene with aspirin, she may also experience confusion, deafness, excessive perspiration, headache, mental dullness, nausea, rapid breathing, rapid pulse, ringing in the ears, vertigo, and vomiting.12
  • Allergic reactions may include rash, hives, difficulty breathing, chest tightness, swollen face and mouth, anxiety, cold and clammy skin, confusion, and unconsciousness.13
Because people can quickly die from a Darvon overdose, they need to get immediate emergency treatment. Doctors may need to use breathing machines, IVs, and various drugs to manage the crisis.

Withdrawal and Treatmentt
A Darvon addict will go through withdrawal symptoms similar to those caused by other opiates. Doctors sometimes have to prescribe drugs such as buprenorphine and naxolene to help the person endure symptoms such as anxiety, tremors, insomnia, sweats, headache, and nightmares.

Teens who abuse drugs often benefit from residential programs such as therapeutic boarding schools or wilderness programs, which help the teens while also separating them from the environment in which they were using drugs.

Teens who abuse drugs often have undiagnosed learning or psychological problems. They may have experiences failures in school because they are dyslexia or have problems processing information. Once these problems are diagnosed and addressed in specialized settings, the teens find that they are able to succeed by setting and surpassing academic goals.

Teens with underlying psychological problems stemming from adoption, family conflicts, and mental disorders often have problems with drugs. For example, depression doubles the risk for teen substance abuse. During residential treatment, counselors work with each teen individually and help them understand and cope with such issues.

As teens recover from substance abuse, they need to find healthy new outlets such as sports or creative arts to fill up the time formally spent pursuing and using drugs. They often need professional help to understand the types of people and situations that can trigger a recurrence of their use, and to develop strategies to avoid such recurrences.

Recovery and rehabilitation takes time, and after teens return home from residential programs, they often need follow-up care in the form of continued counseling or participation in local support meetings such as Narcotics Anonymous.

References
Barkin, R.L. et al. "Propoxyphene (dextropropoxyphene): a critical review of a weak opioid analgesic that should remain in antiquity," American Journal of Therapeutics, November 2006, Volume 13, Number 6, pages 534-42.
"Drug Abuse Sourcebook" Bellenir, Karen. Detroit: Omnigraphics, 2000.
"Prescription Drug Abuse" Colvin, Rod. Omaha, NB: Addicus Books, 2002.
"Darvon Facts and Comparisons," Drugs.com, posted at http://www.drugs.com/cdi/darvon.html
"Darvocet Facts and Comparisons," Drugs.com posted at http://www.drugs.com/darvocet.html
"Darvocet," Physicians Desk Top Reference, posted at http://www.pdrhealth.com/drugs/rx/rx-mono.aspx?contentFileName=Dar1115.html&contentName=Darvocet-N&contentId=160
Dextropropoxyphene, the United States Drug Enforcement Agency, posted at http://www.usdoj.gov/dea/concern/d_p.html
Hedenmalm, Karin (MD). "A Case of Severe Withdrawal Syndrome due to Dextropropoxyphene," Annals of Internal Medicine, Volume 123 Issue 6, 15 September 1995, Page 473.
"The AARP Guide to Pills" Hochadel, Maryanne (PharmD). New York: Sterling Publishing Co., 2006.
Jonasson, Birgitta and Ulf (Phds). "Drugs, Your Right to Know," see http://africarights.wordpress.com/2008/01/10/drugs-your-right-to-know-the-facts-painkillers-part-1/
"Propoxyphene," Drugs.com at http://www.drugs.com/propoxyphene.html
"Public Citizen Sues FDA to act on Darvon," the Associated Press, June 19, 2008, posted at http://www.consumeraffairs.com/news04/2008/06/darvon_pubcit.html
Lanis, Bill. "Darvon, Darvocet," Helping Addicts, A website for addicts and ex-addicts, http://helpingaddicts.net/darvon.htm
Parker, Jim. "Darvon," The DoItNow organization, February 2007, posted at http://www.doitnow.org/pages/157.html
"From Chocolate to Morphine" Weil, Dr. Andrew. New York: Howard Mifflin, 1998.

Footnotes
1Weil, Dr. Andrew. From Chocolate to Morphine. (New York: Howard Mifflin), 1998, pg. 151.
2Parker, Jim. "Darvon," The DoItNow organization, February 2007, posted at http://www.doitnow.org/pages/157.html
3Jonasson, Birgitta and Ulf (Phds). "Drugs, Your Right to Know," see http://africarights.wordpress.com/2008/01/10/drugs-your-right-to-know-the-facts-painkillers-part-1/
4"Dextropropoxyphene," the United States Drug Enforcement Agency, posted at http://www.usdoj.gov/dea/concern/d_p.html
5"Public Citizen Sues FDA to act on Darvon," op cit.
6Bellenir, Karen. Drug Abuse Sourcebook. Detroit: Omnigraphics, 2000, pg. 279.
7"Darvon Facts and Comparisons," Drugs.com, posted at http://www.drugs.com/cdi/darvon.html
8Parker, op cit.
9Lanis, Bill. "Darvon, Darvocet," Helping Addicts, A website for addicts and ex-addicts, http://helpingaddicts.net/darvon.htm
10Barkin, R.L. et al. "Propoxyphene (dextropropoxyphene): a critical review of a weak opioid analgesic that should remain in antiquity," American Journal of Therapeutics, November 2006, Volume 13, Number 6, pages 534-42.
11"Darvocet," Physicians Desk Top Reference, posted at http://www.pdrhealth.com/drugs/rx/rx-mono.aspx?contentFileName=Dar1115.html&contentName=Darvocet-N&contentId=160
12Ibid.
13"Darvon Facts and Comparisons," op cit.