Review
Physician Perspective on Propoxyphene as a Potentially Inappropriate Medication in Tennessee
Abstract
Medicare Part D data from the Quality Improvement Organization's 9th Statement of Work drug safety indicator project under the direction of the Centers for Medicare & Medicaid Services define the potentially inappropriate medications (PIMs) list for Tennessee. These data reveal propoxyphene as the main contributor to the state's PIM rate. In Tennessee, PIM and drug-drug interaction (DDI) rates indicate propoxyphene as the most prescribed medication among elderly patients despite decades of attention for potentially adverse effects. During this project, physicians agreed that PIM rates are too high, but disagreed in approach preference, i.e., administrative limits and bans versus a proactive educational approach. Physicians were interested in participating in quality improvement by using individual pharmacy data to influence prescribing patterns. Exploring alternatives in research and survey, a potential and reachable point of intervention was found, a prescribing paradigm proposed by researchers to improve outcomes by reducing adverse effects in minimizing PIMs and DDIs.This content is limited to qualifying members.
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References
1. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997;157:1531-1536.
2. Garcia RM. Five ways you can reduce inappropriate prescribing in the elderly: a systematic review. J Fam Pract 2006;55:305-312.
3. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a U.S. consensus panel of experts. Arch Intern Med 2003;163:2716-2724.
4. Institute of Medicine. Preventing medication errors [IOM Web site]. July 2006. Available at: http://www.iom.edu/∼/media/Files/Report%20Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.ashx. Accessed October 22, 2010.
5. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. A report of the Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC, National Academy Press, 2000.
6. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004;164:305-312.
7. Liu GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash) 2002;42:847-851.
8. Fick DM, Waller JL, Maclean JR, et al. Potentially inappropriate medication use in a Medicare managed care population: association with higher costs and utilization. J Manag Care Pharm 2001;7:407-413.
9. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 2001;286:2823-2829.
10. Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data.Med Care 1998;36:8-27.
11. Goldstein DJ, Turk DC. Dextropropoxyphene: safety and efficacy in older patients [review]. Drugs Aging 2005;22:419-432.
12. Bateman ND, Sandilands EA. European Medicines Evaluation Agency bans dextropropoxyphene: a landmark decision for clinical toxicology? Clin Toxicol (Phila) 2009;47:782-783.
13. US Food and Drug Administration. FDA takes actions on DARVON, other pain medications containing propoxyphene [FDA Web site]. July 7, 2009. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm170769.htm. Accessed October 22, 2010.
14. US Food and Drug Administration. Propoxyphene questions and answers [FDA Web site]. July 7, 2009. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm170268.htm. Accessed October 22, 2010.
15. Public Citizen's Health Research Group. Public Citizen sues FDA for failing to act on petition to remove Darvon from the market [Public Citizen Web site]. 2008. Available at: http://www.worstpills.org/public/page.cfm?op_id=415. Accessed October 22, 2010.
16. Bannwarth B, Richez C. The dextropropoxyphene controversy [published online ahead of print]. Joint Bone Spine 2009;1476:449-451.
17. Barkin RL, Barkin SJ, Barkin DS. Propoxyphene (dextropropoxyphene): a critical review of a weak opioid analgesic that should remain in antiquity [review]. Am J Ther 2006;13:534-542.
18. Pergolizzi J, Böger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone) [published online ahead of print May 23, 2008]. Pain Pract 2008;8:287-313.
19. Eisenberg E. European pain management discussion forum. J Pain Palliat Care Pharmacother 2008;22:235-238.
20. Committee on the Safety of Medicines of the UK. Overdose risk prompts UK withdrawal of propoxyphene combination. J Pain Palliat Care Pharmacother 2006;20:49-50.
21. Shorr RI, Griffin MR, Daughery JR, et al. Opioid analgesics and the risk of hip fracture in the elderly: codeine and propoxyphene. J Gerontol 1992;47:M111-M115.
22. Smith RG. Fall-contributing adverse effects of the most frequently prescribed drugs. J Am Podiatr Med Assoc 2003;93:42-50.
23. Kamal-Bahl SJ, Stuart BC, Beers MH. Propoxyphene use and risk for hip fractures in older adults. Am J Geriatr Pharmacother 2006;4:219-226.
24. Fahlman C, Lynn J, Finch M, et al. Potentially inappropriate medication use by Medicaid+Choice beneficiaries in the last year of life. J Palliat Med 2007;10:686-695.
25. Basu D, Banerjee A, Harish T, et al. Disproportionately high rate of epileptic seizure in patients abusing dextropropoxyphene. Am J Addict 2009;18:417-421.
26. Gaubert S, Vié M, Damase-Michel C, et al. Dextropropoxyphene withdrawal from a French university hospital: impact on analgesic drug consumption [published online ahead of print March 9, 2009]. Fundam Clin Pharmacol 2009;23:247-252.
27. Castle SC. High-Risk Medications and Falls: A Practical Approach to Risk Management. Clearwater Beach, FL, Third Annual Evidence-Falls Conference, 2002.
28. Morrissey EFR, McElnay JC, Scott M, et al. Influence of drugs, demographics and medical history on hospital readmission of elderly patients: a predictive model. Clin Drug Invest 2003;23:119-128.
29. Evans JG. Drugs and falls in later life. Lancet 2003;361:448.
30. Salzman RT, Brobyn RD. Long-term comparison of ibuprofen and propoxyphene in patients with osteoarthritis. Pharmacol 1983;27:55-64.
31. Hanlon JT, Fillenbaum GG, Kuchibhatla M, et al. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care 2002;40:166-176.
32. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med 2003;348:1556-1564.
33. Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991;151:1825-1832.
34. Starner CI, Norman SA, Reynolds RG, et al. Effect of a retrospective drug utilization review on potentially inappropriate prescribing in the elderly. Am J Geriatr Pharmacother 2009;7:11-19.
