What is the painkiller of choice for LBD?

[Guest guest]

How can I educate Millie's physician if I don't know the answer?

Seems like an question, but I know someone has the answer!

We right now have a choice between DarvocettN and Morphine.

I realize we have to pick the lesser of the evils, and I am not sure I

feel comfortable doing that. I would love a third alternative with no

side effects.

Carol

[Guest guest]

In the past talked alot about Tylenol on a regular basis - read

here:

http://health.groups.yahoo.com/group/LBDcaregivers/message/64777

http://health.groups.yahoo.com/group/LBDcaregivers/message/67256

http://health.groups.yahoo.com/group/LBDcaregivers/message/63344

http://health.groups.yahoo.com/group/LBDcaregivers/message/59153

Then, for more severe pain Dr. Gomperts suggested Darvocet (Darvon)

or Ultram

(http://www.lewybodydementia.org/docs/gomperts_transcript.pdf)

But questions the Darvon suggestion (b/c it's on the Beers list

to not give to the elderly)(out of the 2 he feels Ultram would be

better) See here:

http://health.groups.yahoo.com/group/LBDcaregivers/message/62556

Here's the Beers list:

http://www.prescribingreference.com/pdf/Charts/LTC-Beers%20List.pdf

(listed as " Propoxyphene " )

Interesting read:

http://www.citizen.org/publications/release.cfm?ID=7420

Hope you find the above useful.

>

> How can I educate Millie's physician if I don't know the answer?

>

> Seems like an question, but I know someone has the answer!

>

> We right now have a choice between DarvocettN and Morphine.

>

> I realize we have to pick the lesser of the evils, and I am not

sure I

> feel comfortable doing that. I would love a third alternative with

no

> side effects.

>

> Carol

>

[Guest guest]

Darvocet (Darvon)= Propoxyphene

Propoxyphene use and risk for hip fractures in older adults.

2006 Sep

BACKGROUND: Published guidelines have identified propoxyphene as an

inappropriate medication for use in aged patients. It is no more

effective than acetaminophen, yet has been associated with the same

adverse effects (AEs) associated with other opioid drugs. In

particular, its central nervous system-related AEs, dizziness and

sedation, may increase the risk for fracture resulting from falls in

older adults. Nonetheless, US studies have reported widespread use of

propoxyphene in the elderly US population. OBJECTIVE: The aim of this

study was to examine the risk for fracture associated with

propoxyphene use in older adults. METHODS: This prospective cohort

study used a large administrative claims data set from adults aged >

or =65 years. A time-varying (lagged) covariate defined each person

as a propoxyphene user or nonuser based on propoxyphene exposure in

the 14 days before each fracture event in the cohort. Another time-

varying measure stratified propoxyphene users based on their mean

daily dose of propoxyphene (high dose = >260 mg; low dose = < or =260

mg of propoxyphene hydrochloride or equivalent napsylate salt). Time-

dependent regression models were used to estimate the association

between propoxyphene exposure and occurrence of hip fracture (using

International Classification of Diseases, Ninth Revision, Clinical

Modification code 820.xx). RESULTS: A total of 362,503 patients were

included in the analysis. During a mean follow-up of 464 days,

approximately 10% (37,569) of the sample had > or =1 propoxyphene

prescription filled and approximately l% (5065) sustained a hip

fracture. Propoxyphene users had a 2-fold higher risk for hip

fracture (hazard ratio

---

[95% CI], 2.05 [1.87-2.25]) compared with

nonusers of analgesics. Multivariate analysis found a dose-response

relationship between propoxyphene and hip fracture risk (low dose, HR

[95% CI], 1.45 [1.26-1.67]; high dose, HR [95% CI], 2.05 [1.85-

2.29]). Other opioid analgesics were associated with an increased

risk for hip fractures. CONCLUSIONS: The results of this cohort

database study suggest that propoxyphene use among adults aged > or

=65 years is associated with increased risk for hip fracture and

suggest a need for interventions to reduce propoxyphene use in older

adults. Clinicians should be aware of the risk for hip fracture with

other opioids as well and weigh them against potential benefits when

prescribing for older adults.

Source:

http://www.ncbi.nlm.nih.gov/pubmed/17062322

> >

> > How can I educate Millie's physician if I don't know the answer?

> >

> > Seems like an question, but I know someone has the answer!

> >

> > We right now have a choice between DarvocettN and Morphine.

> >

> > I realize we have to pick the lesser of the evils, and I am not

> sure I

> > feel comfortable doing that. I would love a third alternative

with

> no

> > side effects.

> >

> > Carol

> >

>