Mort Jane R, Schroeder Stephan D
South Dakota State University College of Pharmacy, USA.
S D Med. 2009 Nov;62(11):433-5.
Pain is frequently reported and often undertreated in the elderly population. In light of these concerns, it is important to examine potentially ineffective or problematic pain medications. Propoxyphene is one such agent whose efficacy and safety have been questioned by researchers, clinicians and the U.S. Food and Drug Administration (FDA). Specifically, multiple studies have found propoxyphene to be no more effective than acetaminophen (APAP), yet propoxyphene causes opioid side effects and has been involved in many drug-related deaths. In addition, propoxyphene/APAP products are often prescribed at doses that exceed maximum values (49.2 percent of APAP/propoxyphene napsylate 100 prescriptions for South Dakota Medicaid patients exceeded the maximum daily dose). The relevance of propoxyphene use is seen by the 7.1 percent prevalence of propoxyphene prescriptions among the South Dakota Medicare beneficiaries, which is comparable to the 6.8 percent reported in the U.S. community-based Medicare population. Therefore, it is very important to consider alternatives to propoxyphene such as APAP, nonsteroidal anti-inflammatory drugs (rare use due to adverse effects) and other opioids, when managing elderly patients with pain.
疼痛在老年人群中经常被报告，但往往治疗不足。鉴于这些问题，研究可能无效或有问题的止痛药物很重要。丙氧芬就是这样一种药物，其疗效和安全性受到了研究人员、临床医生以及美国食品药品监督管理局（FDA）的质疑。具体而言，多项研究发现丙氧芬并不比对乙酰氨基酚（APAP）更有效，但丙氧芬会引起阿片类药物的副作用，并且与许多药物相关死亡事件有关。此外，丙氧芬/APAP产品的处方剂量常常超过最大值（南达科他州医疗补助患者的49.2%的APAP/萘磺酸丙氧芬100处方超过了最大日剂量）。南达科他州医疗保险受益人中丙氧芬处方的患病率为7.1%，这与美国以社区为基础的医疗保险人群中报告的6.8%相当，由此可见丙氧芬使用的相关性。因此，在治疗老年疼痛患者时，考虑使用丙氧芬的替代品，如APAP、非甾体抗炎药（因副作用很少使用）和其他阿片类药物非常重要。
