Alcohol
Contraindicated
Database
Additive CNS/respiratory depression
Avoid; major contributor to historical deaths
Source: Kimi deep-research + Cla
Drug reference
dextropropoxyphene
Opioid analgesic (weak mu-agonist; largely withdrawn) · analgesic
START
Use discouraged; if unavoidable 65 mg q6–8h
TYPICAL MAX
~390 mg/day (historical; prefer safer analgesics)
STOP IF
Any arrhythmia/QRS widening, sedation, or respiratory depression
WATCH
ECG (QRS/QT), sedation/respiration; avoid alcohol absolutely
CDSCO approvedATC N02AC04
KDIGO 2024 + manufacturer label
- ONSET
- 45min · absorption
- PEAK
- 2.3h · Tmax
- t½
- 10h · t½ (parent)
- DURATION
- 5h · per dose
EXCRETION
Renal — metabolites (norpropoxyphene)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid; neonatal withdrawal/respiratory depression.
FDA category + note
Top interactionssee all 12 →
- AlcoholContraindicatedDatabaseKimi deep-research + Cla
- AlimemazineSevereDatabaseDDInter
- AlprazolamSevereDatabaseDDInter
- AlvimopanSevereDatabaseDDInter
Mechanism
Weak mu-opioid receptor agonist; the metabolite norpropoxyphene is cardiotoxic (sodium-channel blockade → QRS/QT prolongation, arrhythmia), which underlies its withdrawal from many markets.
Indications
Mild-to-moderate pain (historical; withdrawn in many countries due to cardiotoxicity/overdose risk)
Dosing
- Adult
- Historical: dextropropoxyphene 65 mg (HCl) or 100 mg (napsylate) every 6–8 h; max ~390 mg HCl/day. Use discouraged/withdrawn.
- Pediatric
- Not recommended.
- Renal adjustment
- Reduce dose / avoid in renal impairment (metabolite accumulation).
- Hepatic adjustment
- Reduce dose / avoid in hepatic impairment.
- Geriatric
- Avoid (cardiotoxicity, falls, accumulation).
- Max dose
- ~390 mg/day dextropropoxyphene hydrochloride (historical ceiling)
Pharmacokinetics
Onset
~30–60 min (oral)
Peak effect
~2–2.5 h (Tmax)
Duration
~4–6 h
Half-life
~6–12 h (norpropoxyphene 30–36 h — accumulates)
Bioavailability
Variable (extensive first-pass)
Protein binding
~80%
Metabolism
Hepatic N-demethylation to norpropoxyphene (cardiotoxic)
Excretion
Renal (metabolites)
Contraindications
- Suicidal/addiction-prone patients
- Concomitant use with alcohol or other CNS depressants/sedatives
- Severe respiratory depression
- Hypersensitivity
- Use generally not recommended (withdrawn)
Side effects
Common
DizzinessSedationNauseaConstipationHeadache
Serious
- Fatal cardiotoxicity (norpropoxyphene — arrhythmia, QRS/QT prolongation)
- Respiratory depression
- Overdose death (esp. with alcohol)
- Dependence
Pregnancy & lactation
Pregnancy
Avoid; neonatal withdrawal/respiratory depression.
Lactation
Small amounts in milk; avoid (safer alternatives).
Drug interactions
Alimemazine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Alprazolam
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Alvimopan
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amiodarone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amitriptyline
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amobarbital
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Amoxapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Apomorphine
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Aripiprazole
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Related guidelines
Ask House about dextropropoxyphene
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20