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Although commonly ordered as a "safe drug that is stronger than Tylenol®," propoxyphene-containing products (Darvon®, Darvocet-N®) are not recommended for pain management in the elderly.
Some studies find that propoxyphene is no more effective than aspirin or acetaminophen in treating pain, yet it has narcotic side effects (constipation, CNS depression, etc.).
It also has an active metabolite, norpropoxyphene, which is associated with cardiac and CNS toxicity.
Propoxyphene should be avoided in the elderly.
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- Avoid propoxyphene-containing products.
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Meperidine is not recommended for pain management in the elderly due to the accumulation of its metabolite, normeperidine, which is associated with serious CNS side effects including tremor and seizures.
Meperidine also is not an effective oral analgesic.
There are many other effective opiate analgesics. Meperidine should be avoided in the elderly.
(Beers MH. Arch Intern Med 1997;157:1531-1536; Semla TP, Beizer JL, Higbee MD. Geriatric Dosage Handbook, 8th edition. Hudson (Cleveland): Lexi-Comp Inc., 2003.)
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