Correlation between prescription of various dextropropoxyphene preparations and their involvement in fatal poisonings

In Sweden, the frequency of fatal poisoning by dextropropoxyphene (DXP) ing estion is constantly high. There are seven preparations containing DXP on t he Swedish market; in three of them DXP is the sole analgesic ingredient, w hile four of them are combinations of analgesics. In an attempt to assess t he death rate attributable to each DXP preparation on the basis of toxicolo gical analyses, altogether 834 cases of dextropropoxyphene-related death ov er a 5-year period (1992-1996) in Sweden have been reviewed. The ratio betw een number of fatal poisonings and prescription of defined daily dose/1000 inhabitants during a 12-month period (DDD) was determined. The highest rati o, 27, was attributed to unmixed preparations. The ratio for DXP+ paracetam ol-related deaths was 6.3, acid for DXP+phenazone, 6.4, while the lowest ra tio, 2, was found among the DXP+chlorzoxazone cases. The unmixed preparatio ns, representing 26% of all DXP prescriptions during the study years, were implicated in 62% of the DXP fatalities, a considerable over-representation . Unmixed preparations, with their higher content of DXP, may be more attra ctive for many consumers because of their narcotic (euphoric) effects rathe r than for any analgetic superiority. Another possibility is that unmixed p reparations may erroneously have been regarded as safer than when combined with paracetamol, as reports of poisoning with compounds containing DXP+par acetamol have been most frequently reported, probably due to their predomin ance on the market. (C) 1999 Elsevier Science Ireland Ltd. All rights reser ved.