Distalgesic poisoning—cause for concern

Abstract

A review of all dextropropoxyphene poisoning episodes in a stable representative population during the past 10 years showed that Distalgesic accounts for most overdoses, and it has become an increasingly popular component of self-poisoning cocktails. Sudden respiratory depression due to dextropropoxyphene potentiated by other common ingested agents is the main danger, and at least one-third of patients take a potentially lethal dose (20 tablets of Distalgesic and alcohol or benzodiazepine). Naloxone is an effective antagonist but, because of the rapidity of deterioration, 40% of patients sustain irreversible cerebral damage before reaching resuscitation facilities. Consequently Distalgesic has become the ingested agent principally responsible for self-poisoning deaths over the age of 12 years. This rise to prominence has paralleled a pronounced increase in prescriptions for the drug. The reason for the increased rise in self-poisoning remains elusive. As effective treatment of the cause is not possible the only way to mitigate its serious consequences is prompt treatment and restrictions on the availability of the drug. No analgesics are devoid of danger in overdose, but in dextropropoxyphene the evidence suggests that its dangers outweigh its analgesic properties. © 1980, British Medical Journal Publishing Group. All rights reserved.