Darvon and Darvocet have a lot of fans.
We learned that after writing last Friday that the FDA had requested manufacturers stop making the painkillers because of evidence that propoxyphene (the generic name for Darvon; Darvocet includes that ingredient plus acetaminophen) raises the risk of dangerous heart rhythm changes.
Public Citizen, which had long pressed for the drug’s removal, was happy; some (though definitely not all) Health Blog commenters were not:
“My mother is 95. She has an allergy to morphine. Darvon and Darvocet were the only pain meds that the PA could prescribe. What does she take now[?]“ wrote Kateb.
“I’ve been on Darvocet for 1 week now for a herniated disc/annular tear. I can’t take oxycodone because of severe vomiting. I figure I’ll just [be] careful and not over use it,” wrote LaLa.
And Sarah wrote: “I have taken this pain killer off and on for 30 years..I cannot tolerate ANY other. I have had severe reactions to anything morphine based or any synthetics that are similar to morphine, codeine etc. What is the alternative??”
There’s no single answer to that question, says Edward Michna, an assistant professor at Harvard Medical School who practices anesthesiology and pain management at Brigham and Women’s Hospital. Responses to pain meds vary, and in many cases, medicine is “not sophisticated enough to understand why,” he says. (Michna is also chair of the American Pain Society’s public policy committee.)
Needless to say, patients who take Darvon or Darvocet should have a conversation with their physician about the next step. The drugs were indicated for mild to moderate pain, such as that from osteoarthritis, Michna tells the Health Blog. That might suggest a chat about switching to Tylenol, with or without codeine, or non-steroidal anti-inflammatory drugs such as ibuprofen.
But those have their downsides, too, he says. Codeine, for example, makes a lot of people nauseous or sparks other GI problems, while ibuprofen can cause GI bleeding.
Other drugs indicated for moderate to moderately severe pain, such as tramadol, and tapentadol (sold under the brand name Nucynta), for moderate to severe acute pain, may also be possibilities, says Michna. “In pain, we have to individualize care based on the individual and prior experience,” he says. (In some cases, that may mean your doctor will recommend trying more powerful painkillers such as oxycodone or hydrocodone-containing drugs, which are intended for serious pain.) Of course, all drugs have risks in addition to benefits, so be sure to ask your physician about those.
For those who have had success at pain control using propoxyphene, the transition may not be easy. “It’s hard for people to switch,” Michna says. And, he adds, despite the fact that pain is the most common reason for visiting a physician, we are still very ignorant about chronic pain, pointing to the need for more research — and funding.
Photo by greefus groinks via Flickr
