Pharmaceutical Research

Although inappropriate for use in older adults, propoxyphene was widely prescribed to elderly patients in the 1990s

Tthe narcotic pain reliever propoxyphene is considered inappropriate for use in older adults; however, it was prescribed to nearly 7 percent of elderly community-dwelling Medicare patients in the 1990s. In fact, over 2 million Medicare beneficiaries received this drug in 1999, according to a new study. While propoxyphene has been shown to be not much more effective than aspirin, it can cause sedation and dizziness, increasing the risk of elderly falls and fractures.

Researchers, supported by the Agency for Healthcare Research and Quality (HS13551), used data from the Medicare Current Beneficiary Survey (MCBS) to examine the prevalence of propoxyphene use from 1993 through 1999 on a nationally representative sample of community-dwelling elderly Medicare beneficiaries. They linked the 1999 MCBS with the 1999 Area Resource File to examine patient and physician factors associated with its use at the county level.

The rate of propoxyphene use was stable during the study period, ranging from an annual prevalence of 6.8 percent in 1993 to a slight decrease to 6.6 percent in 1999. Propoxyphene use may have begun to decline after 1997, when the first set of pain management guidelines was published that advised against its use in the elderly. During the study period, male physicians were 34 percent more likely than female physicians and medical specialists were 19 percent less likely than generalist physicians to prescribe propoxyphene to elderly Medicare patients. Also, Medicaid beneficiaries were 40 percent more likely to receive propoxyphene than those without drug coverage.

See "National trends in and predictors of propoxyphene use in community-dwelling older adults," by Sachin Kamal-Bahl, Ph.D., Bruce C. Stuart, Ph.D., and Mark H. Beers, M.D., in the September 2005 American Journal of Geriatric Pharmacotherapy 3(3), pp. 186-194.

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