Download Propoxyphene MD Letter - Maryland Physicians Care

Dear Provider:
After consideration by the Maryland Physicians Care Pharmacy and Therapeutic Committee, we would like to
inform you of a change on the Preferred Drug List (PDL). Effective June 1, 2010, generic propoxyphene and
propoxyphene-containing combinations will be non-formulary and require prior authorization for Maryland
Physicians Care.
 Maryland Physicians Care will grandfather all members currently on generic propoxyphene and
propoxyphene-containing combination therapy.
 Preferred drug list alternatives include: tramdol, ibuprofen, or naproxen. Please refer to Maryland
Physicians Care PDL for a list of other formulary alternatives:
http://www.marylandphysicianscare.com/pdf/MPC_Formulary.pdf
 Clinical studies have shown the following:
 In a comprehensive survey of published literature, Miller, et al.,1 examined 243 articles on
propoxyphene and found few hard data on its therapeutic value compared with other analgesics.
Seven of the 16 reviewed studies compared propoxyphene with placebo (4 of which used the
manufacturer’s suggested dose of 65 mg) and showed that propoxyphene was not superior to
placebo.
2
 Hopkinson, et al., compared the analgesic effect of two combinations of drugs: 1) 1000 mg
acetaminophen alone and 2) 650 mg acetaminophen plus 100 mg propoxyphene. Results showed
that the acetaminophen-only treatment was significantly more effective than the
propoxyphene/acetaminophen combination for the relief of pain (63% vs. 42% achieving effective
pain relief), indicating that propoxyphene adds no analgesic properties to acetaminophen. NOTE: FOR
MARYLAND PHYSICIANS CARE THE QUANTITY LIMIT FOR ALL PRESCRIPTION AND OTC
ACETAMINOPHEN PRODUCTS IS 4 GRAMS/DAY.
 Propoxyphene can cause severe cardiovascular effects with overdose or even when used as
directed.3 When metabolized, a majority of propoxyphene is converted into norpropoxyphene, which is
2.5 times more potent than its parent compound in producing cardiac depression and has a half-life of
approximately 36 hours, three times longer than that of propoxyphene. 3
 Central nervous system-related adverse effects of propoxyphene use may increase the likelihood of falls
and fall-related fractures in the elderly. As defined by the Beers criteria propoxyphene is a drug
inappropriate for prescription to the elderly.4
Maryland Physicians Care appreciates the time and effort that you spend caring for our members. We believe
that through a combined effort we can continue to provide affordable, quality care for Maryland Physicians
Care members.
Sincerely,
Nina F. Miles Everett, M.D.
Medical Director for Maryland Physicians Care
References: 1. Miller RR, et al.. Propoxyphene hydrochloride: a critical review. JAMA. 1970; 213(6): 996-1006. 2. Hopkinson JH 3rd, Blatt G, Cooper
M. Effective pain relief: comparative results with acetaminophen in a new dose formulation, propoxyphene napsylate-acetaminophen combination, and
placebo. Curr Ther Res Clin Exp. 1976 Jun; 19(6): 622-630. 3. Propoxyphene: safety and efficacy. Pharmacist's Letter/Prescriber's Letter
2009;25(3):250301. 4. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate
medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716-2724.