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Finally, after years of problems associated with propoxyphene (Darvon and Darvocet), the FDA has asked that all related products, both brand and generic, be withdrawn from the U.S. market.²⁶ Recent clinical data was reported showing that propoxyphene increased the risk of potentially serious or fatal arrhythmias, which has tipped the balance toward greater risk. For long-time users of propoxyphene, it is worth noting that the arrhythmogenic potential of propoxyphene is not cumulative, and dissipates upon discontinuation of the agent if used long term. Geriatric pharmacotherapy specialists are applauding this move because it is a Beers Criteria drug, one that is potentially inappropriate for use in older adults and shows no benefit—only greatly increased—risk in this patient population. The Beers criteria were adopted by the Centers for Medicare & Medicaid Services for nursing home regulations and more recently in the development of Medicare Part D initiatives.²⁷ Propoxyphene has been well known to offer few analgesic advantages over acetaminophen while conferring significant risk, including narcotic adverse effects.

Michele Kaufman is a freelance medical writer based in New York City and a clinical pharmacist at New York Downtown Hospital.

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