Deaths from Paracetamol and Dextropropoxyphene (Distalgesic) Poisoning in England and Wales in 1979

Vale, J. A.; Buckley, B M; Meredith, T. J.

doi:10.1177/096032718400300114

Cited by 18 publications

(8 citation statements)

References 19 publications

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“…Propoxyphene (Darvon) is a frequently used synthetic opiate analgesic that is often implicated in drug overdose (1)(2)(3)(4). Propoxyphene overdose causes profound cardiorespiratory and neurologic effects.…”

Section: Introductionmentioning

confidence: 99%

Marked QRS complex abnormalities and sodium channel blockade by propoxyphene reversed with lidocaine.

Whitcomb

Gilliam²,

Starmer

et al. 1989

J. Clin. Invest.

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The opiate analgesic propoxyphene produces cardiac toxicity when taken in overdose. We recently observed a patient with propoxyphene overdose in whom marked QRS widening was reversed by lidocaine. The reversal is apparently paradoxical as both agents block the inward sodium current (IN.). We examined possible mechanisms of the reversal by measuring INa in rabbit atrial myocytes during exposure to propoxyphene and the combination of propoxyphene and lidocaine (60 and 80 MM, respectively). Propoxyphene caused use-dependent block of IN. during pulse train stimulation. Block recovered slowly with time constants of 20.8±3.9 s. Block during lidocaine exposure recovered with time constants of 2-3 s. During exposure to the mixture, block recovered as a double exponential. The half time for recovery during exposure to the mixture was 1.6±.9 s compared with a half-time of 14.3±2.9 s during exposure to propoxyphene alone. During pulse train stimulation, less steady-state block was observed during exposure to the mixture than during exposure to propoxyphene alone when the interval between pulses was > 0.95 s. Both drugs compete for a common receptor during the polarizing phase. The more rapid dissociation of lidocaine during the recovery period leads to less block during the mixture than during exposure to propoxyphene alone. The experiments suggest a mechanism for reversal of the cardiac toxicity of drugs which have slow unbinding kinetics.

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Section: Introductionmentioning

confidence: 99%

Marked QRS complex abnormalities and sodium channel blockade by propoxyphene reversed with lidocaine.

Whitcomb

Gilliam²,

Starmer

et al. 1989

J. Clin. Invest.

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“…The observation that dextropropoxyphene poisoning is part icularly dangerous in combination with other CNS depressants has been confirmed by other authors (Baselt et al 1975;Carson & Carson 1977;McBay et al 1974;Monfarte & Spitz 1976;Sturner & Garriott 1973;Vale et al 1984;Wetli & Bednarczyk 1980), as has its toxicity soon after ingestion (Carson & Carson 1977;Myers et al 1981;Simonsen 1977;Starkey & Lawson 1978;Whittington 1r;77). The limited number of total community surveys which have been performed to date have produced results similar to our own.…”

Section: Mortalitymentioning

confidence: 66%

Dextropropoxyphene Overdose

Lawson

Northridge

1987

Medical Toxicology

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This paper comprehensively reviews the worldwide situation regarding acute overdosage of dextropropoxyphene (propoxyphene). The changing epidemiology of this type of poisoning over the last 20 years is described with discussion of concurrent trends and, in particular, the effects of different preventive measures adopted in various countries. The clinical pharmacology of dextropropoxyphene relevant to the clinical toxic effects resulting from acute overdosage is described, and the management is detailed. In particular, the importance of early diagnosis and treatment is stressed in view of the potentially lethal complications that may suddenly occur with this poisoning. Recommendations for the correct use of the specific narcotic antagonist, naloxone, are made, together with other intensive supportive measures. As dextropropoxyphene is frequently taken together with other toxic agents, the concomitant effects of alcohol and sedative drugs are described and the treatment of paracetamol (acetaminophen) in combination with dextropropoxyphene is emphasised. The most effective preventive measures for the future are suggested, but caution is advised regarding the prescription for 'at risk' patients of alternative analgesics, which may be no safer in overdosage.

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“…The twelve prisoners thus selected for whom, surprisingly, there were formal findings only are listed in Table 3. Sixty-two-year-old JB's death together with AT's death -both on remand at HMP Edinburgh, and within three months of each other, see Table 3 and above at Rule 1 -should have warranted serious adverse event notifications to the Medicines and Healthcare Products Regulatory Authority (Carson 1977;Vale, Buckley and Meredith 1984;Lawson and Northbridge 1987;Obafunwa, Busuttil and al-Oqleh 1994).…”

Section: Methodsmentioning

confidence: 99%

Fatal Accident Inquiries into 97 Deaths Over Five Years in Scottish Prison Custody: Long Elapsed Times and Recommendations

Bird

2008

The Howard Journal of Criminal Justice

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In March 2005, The Herald newspaper reported the findings of a fatal accident inquiry into JCB's death in a Scottish prison on 11 January 2002. Statistically, how exceptional was an elapsed time of 38 months? Freedom of Information requests yielded answers for 97 deaths over five years in Scottish prison custody. Written determinations were made in 42/97 fatal accident inquiries: waiting for dissemination took more than 90 days (10) or from death to dissemination more than 455 days (10) for nearly a third (13/ 42). Three written determinations identified precautions that might have prevented the prisoner's death. From death to end of inquiry took over a year for 21 inquiries, eight of which made only formal findings. Long elapsed times, prisoner's young age or exceptional cause of death suggested three epidemiological rules for helping lawyers in selecting past inquiries for scrutiny, and sheriffs in deciding to make a written determination. Missed suicide watches featured in four determinations but stringency of judgment differed.

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Deaths from Paracetamol and Dextropropoxyphene (Distalgesic) Poisoning in England and Wales in 1979

Cited by 18 publications

References 19 publications

Marked QRS complex abnormalities and sodium channel blockade by propoxyphene reversed with lidocaine.

Marked QRS complex abnormalities and sodium channel blockade by propoxyphene reversed with lidocaine.

Dextropropoxyphene Overdose

Fatal Accident Inquiries into 97 Deaths Over Five Years in Scottish Prison Custody: Long Elapsed Times and Recommendations

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