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Use of dextropropoxyphene + acetaminophen fixed‐dose combination in psychiatric hospital in Bahrain: is there a cause for concern?
Author(s) -
Al Khaja Khalid A. J.,
AlHaddad Mohammed K.,
AlOffi Adel R.,
Abdulraheem Masooma H.,
Sequeira Reginald P.
Publication year - 2009
Publication title -
fundamental and clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.655
H-Index - 73
eISSN - 1472-8206
pISSN - 0767-3981
DOI - 10.1111/j.1472-8206.2008.00662.x
Subject(s) - propoxyphene , acetaminophen , medicine , fixed dose combination , medical prescription , emergency medicine , anesthesia , analgesic , pharmacology
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 ≥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.