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Pharmacy and Medications

Substitute for Darvocet N 100

11/30/2010

Question:

my mother has been taking 1 darvocet n 100 rtc q 6hrs for osteoarthritis pain for 12 years having failed all other pain relief trials-she`s severely allergic to most other opiates-(causes severe agitation/confusion/delirium) except actual morphine & she`s allergic to ibuprofen(causes whelps/rash)-what is the closest chemical relative or class of pain relievers that she could most likely try to transition to for moderate oa pain relief

Answer:

Thank you for contacting NetWellness. As you know, the combination of propoxyphene and acetaminophen, marketed as Darvocet N, has been withdrawn from the United States market due to concerns for heart problems. 

* Learn important new information concerning the FDA withdrawal of the medication Propoxyphene(Darvon, Darvocet)

Alternatives for the treatment of osteoarthritis include acetaminophen alone, non-steroidal anti-inflammatory drugs (NSAIDs), and other weak opioid drugs (codeine, etc.) In your mother's case, allergies will limit some of these options.  You should have a discussion with her and her physician to review the benefits and risks to any alternative treatments. 

Acetaminophen alone may be a good option, especially since some studies have found little difference in pain control between acetaminophen alone or acetaminophen with propoxyphene. 

With an ibuprofen allergy, NSAIDs would have to be used with caution. You should discuss the possibility of trying selective NSAIDs, like celecoxib (Celebrex). Her physician can review the risks of having a reaction with you. 

Topical medications, like capsaicin cream, may provide some relief, as well. Some NSAIDs are available in topical forms. Since these are available with NSAIDs that are similar to ibuprofen, her physician may or may not want to try these as an alternative. 

Finally, other weak opioid medications may be an option. Tramadol (Ultram) or tramadol with acetaminophen (Ultracet) may be an option. It is chemically different than other opioid drugs. Your mother may tolerate codeine since it is chemically very similar to morphine (in fact, the body converts part of a codeine dose to morphine). 

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Response by:

Michael  Ganio, PharmD Michael Ganio, PharmD
Clinical Applications Pharmacist
Wexner Medical Center
The Ohio State University