Archive for: November, 2010

Defective Product Alert: Severe Frostbite and Nerve Damage From Use of Cold Therapy Machines

As of late, reports have been circulating about the potential for permanent nerve damage and skin damage resulting from the use of cold therapy – cryotherapy devices such as PolarCare, EBIce,  Don Joy. These products are defective and the public should generally be aware of the dangers associated with them. If cold therapy devices are used too long, or at too cold of a temperature, it can result in serious injuries such as nerve damage, chronic pain, or frost bite. With few or no instructions or warnings, patients may be subjecting skin and underlying nerves to unacceptably cold temperatures for extended periods of time. Since cold &  ice therapy can desensitize the affected area, serious injuries often occur without the patient’s immediate knowledge. Case studies have documented this injury pattern. 

Cold therapy machines and cryotherapy devices prescribed by doctors are essentially small ice coolers which a patient fills with ice and water, and uses with an attached conforming device to chill a certain area of the body. A small motor inside the cooler circulates the chilled water through the plastic bladder that is placed on a patient’s affected area. The circulated ice water super chills the targeted area of the body, usually the feet, knees, ankles and shoulders.  While it may dull the pain, it also may numb the area to a point where the patient is unaware of the resulting frostbite and permanent nerve damage.  It can have disastrous consequences due to the defective nature of the product and lack of warnings and instructions.

Why Cold Therapy Ice Machines are Defective

Many cold therapy machines are defective in design. Their super cooling capabilities can cause serious crynotherapy frostbite injuries to both the skin and permanent nerve damage to the nerves of the area where the product is applied. The cold therapy machines are defective because there is no regulation of the temperature or how cold the device will make the patient’s skin. There are also very few instructions or warnings provided with the Cold Therapy units dictating how long a patient can super chill a certain area of the body without risking a frostbite type injury. These devices are particularly dangerous, since once an area of a patient’s body is super-chilled, it becomes numb and the patient is unable to feel the frostbite injury occurring, often leading to even greater injury.

Known Cold Therapy Ice Machine Injuries

Often, a patient will awaken from surgery or other forms of treatment, only to find that a Cold Therapy Unit had been applied to them immediately after surgery without their knowledge or understanding.  In many of these cases, the Cold Therapy machine had been in place on the patient’s body for several hours even before they awaken, at far too low a temperature setting, thus possibly having already caused serious frostbite and permanent nerve damage injuries. The types of injury resulting from these cryotherapy or cold therapy machines and devices are primarily frostbite. This type of injury is characterized by decreased blood flow and heat delivery to body tissues resulting in disastrous ice crystal formation within the cells of the skin. These skin injuries can be classified as deep or superficial depending on the depth of injury and length of the crynotherapy cold exposure. They can involve the skin, while more serious injuries extend into the muscle and involve the nerves and even bone. These injuries can cause permanent nerve damage and chronic debilitating pain. Case studies have documented this injury pattern.

Cold Therapy Attorney

Poorly designed cold therapy machines can cause permanent skin damage (frost bite), nerve damage, and numerious other serious side effects. Seek immediate medical attention if you are suffering an emergency situation.

Cold therapy lawsuits are being filed by lawyers representing victims injured by these defective products. Cold therapy lawsuits claim that the cold therapy machines were defective in their design by not having adequate safety mechanisms to prevent injury. Cold machine lawsuits also claim these devices fail to adequately warn consumers of the risks involved with extended or prolonged use of their product.

If you or someone you know has been severely injured as a result of cold therapy, ice machines, recirculating ice coolers, cryotherapy or other forms of cold treatment, talk to a Cold Therapy Attorney at the Willis Law Firm in Houston for legal advice about a potential cold therapy lawsuit.  Please fill out the Free Case Evaluation at the right or call us toll-free at 1-800-883-9858.

What is Reflex Sympathetic Dystrophy (RSD)?

RSD is a chronic nervous system condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury, as in the case of exposure to extremely low temperatures for extended periods of time.  Recently the US FDA has linked the use of certain types of Cold Therapy Ice Machines with these types of injuries and syndromes. 

The condition called “causalgia” was first documented in the 19th century by physicians concerned about pain that Civil War veterans continued to experience after their wounds had healed. Doctors often called it “hot pain,” after its primary symptom. Over the years, the syndrome was classified as one of the peripheral neuropathies, and later, as a chronic pain syndrome. Currently, there are two types that are differentiated-type I and type II. Both types share the same basic set of symptoms, but have one distinct difference: type I (previously referred to as RSD) describes cases in which there is no nerve injury, while type II (formerly called causalgia) refers to cases in which a distinct nerve injury, for example from a gunshot wound, has occurred

What are the Symptoms of Reflex Sympathetic Dystrophy (RSD)?

The symptoms of RSD usually occur near the site of an injury, either major or minor, and include: burning pain, muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin. One visible sign of RSD near the site of injury is warm, shiny red skin that later becomes cool and bluish.

The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. It is frequently characterized as a burning, aching, searing pain, which may initially be localized to the site of injury or the area covered by an injured nerve but spreads over time, often involving an entire limb. It can sometimes even involve the opposite extremity. Pain is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy.

The symptoms of RSD vary in severity and duration. However, there are usually three stages associated with RSD, and each stage is marked by progressive changes in the skin, nails, muscles, joints, ligaments, and bones. Stage one lasts from 1 to 3 months and is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.

In stage two, which lasts from 3 to 6 months, the pain intensifies. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.

As the patient reaches stage three, changes in the skin and bones become irreversible, and pain becomes unyielding and may now involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed.

What Causes Reflex Sympathetic Dystrophy (RSD)?

RSD was originally thought to be the result of malfunctioning nerves of the sympathetic nervous system-the part of the nervous system responsible, for example, for controlling the diameter of blood vessels. This idea has been called into question and the mechanism remains controversial.

Since RSD is most often caused by trauma to the extremities, other conditions that can bring about RSD include sprains, fractures, surgery, damage to blood vessels or nerves, and cerebral lesions. The disorder is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels, and bones.  Recently Cold Therapy Ice Machines have been linked to RSD resulting from cryotherapy.  The FDA has issued a warning related to the improper use of Cold Therapy Ice Machines made by manufacturers such as DonJoy, PolarCare, & EBIce.  These crynotherapy units, when used for prolonged periods or at temperature settings too low, have been linked to permanent nerve damage such as RSD and CPND.

Who Gets Reflex Sympathetic Dystrophy (RSD)?

RSD can strike at any age, but has usually been more common between the ages of 40 and 60. Recent reports show that the number of RSD cases among adolescents and young adults is increasing. It affects both men and women, but is most frequently seen in women.

Investigators estimate that two to five percent of those with peripheral nerve injury and 12 to 21 percent of those with hemiplegia (paralysis of one side of the body) will suffer from RSD.

How is Reflex Sympathetic Dystrophy (RSD) diagnosed?

RSD is often misdiagnosed because it remains poorly understood. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery.

RSD is diagnosed primarily through observation of the symptoms. However, some physicians use thermography (a diagnostic technique for measuring blood flow by determining the variations in heat emitted from the body) to detect changes in body temperature that are common in RSD. A color-coded thermogram of a person in pain often shows an altered blood supply to the painful area, appearing as a different shade (abnormally pale or violet) than the surrounding areas of the corresponding part on the other side of the body. An abnormal thermogram in a patient who complains of pain may lead to a diagnosis of RSD. X-rays may also show changes in the bone.

What is the Prognosis Associated with Reflex Sympathetic Dystrophy (RSD)?

Good progress can be made in treating RSD if treatment is begun early, ideally within 3 months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb and changes in bone and muscle may become irreversible. In 50 percent of RSD cases, pain persists longer than 6 months and sometimes for years.

What is the Treatment for Reflex Sympathetic Dystrophy (RSD)?

Physical therapy is the mainstay of therapy. Physicians use a variety of drugs to treat RSD, including corticosteroids, vasodilators, and alpha- or beta-adrenergic-blocking compounds. Elevation of the extremity may be helpful. Injection of a local anesthetic, such as lidocaine, is sometimes used. Injections are repeated as needed. TENS (transcutaneous electrical stimulation), a procedure in which brief pulses of electricity are applied to nerve endings under the skin, has helped some patients in relieving chronic pain.

In some cases, surgical or chemical sympathectomy-interruption of the affected portion of the sympathetic nervous system-has been used to relieve pain. Surgical sympathectomy involves cutting the nerve or nerves, destroying the pain almost instantly. But surgery is controversial and may also destroy other sensations.

 Other Disorders Similar to Reflex Sympathetic Dystrophy (RSD)

RSD has characteristics similar to those of other disorders, such as shoulder-hand syndrome, which sometimes occurs after a heart attack and is marked by pain and stiffness in the arm and shoulder; Sudeck’s syndrome, which is prevalent in older people and in women and is characterized by bone changes and muscular atrophy, but is not always associated with trauma; and Steinbrocker’s syndrome, which affects both sexes but is slightly more prevalent in women, and includes such symptoms as gradual stiffness, discomfort, and weakness in the shoulder and hand.

Cold Therapy Attorney

Poorly designed cold therapy machines can cause permanent nerve damage, frostbite, and numerious other serious side effect injuries. Seek immediate medical attention if you are suffering an emergency situation.

Cold therapy lawsuits are currently being filed by attorneys representing victims injured by these defective products. Cold therapy lawsuits claim that the cold therapy machines were defective in their design by not having adequate safety mechanisms to prevent injury. Cold machine lawsuits also claim these devices fail to adequately warn consumers of the risks involved with extended or prolonged use of their product.

If you or someone you know has been injured as a result of cold therapy, ice machines, recirculating ice coolers, cryotherapy or other forms of cold treatment, talk to a Cold Therapy Machine Attorney at the Willis Law Firm in Houston for legal advice about a potential cold therapy – cryotherapy lawsuit.  Please fill out the Free Case Evaluation at the right or call us toll-free at 1-800-883-9858.

PML is a rare disorder that damages the material that covers and protects the nerves in the white matter of the brain. It is caused by the reactivation of the JC virus in the body and it infects the brain. JC virus is commonly acquired in childhood, but most people do not develop PML. The virus usually remains inactive and hardly ever causes symptoms-unless you have a significantly weakened immune system. People who have received Tysabri infusions, have AIDS, leukemia or lymphoma typically have a compromised immune system.

PML and Tysabri

Tysabri (Natalizumab) is a drug manufactured by Biogen Idec Inc. and Elan Corp. It is used to treat the symptoms of Multiple Sclerosis (MS) and Crohn’s disease, a gastrointestinal disorder. It is normally used after other treatments have not worked; it is not a cure, but a treatment. Tysabri is an immunosuppressant infusion that is used to help control the symptoms of relapsing MS (when the symptoms get worse then improve, and get worse again.) The use of Tysabri has been linked to PML (Progressive multifocal leukoencephalopathy), a rare but life threatening brain infection. The longer Tysabri is used, the more likely the risk of contracting PML.

Symptoms of PML

There is no “usual” course of PML, the area of the brain that is affected will determine how PML symptoms will appear. The symptoms can be similar to those of MS, and worsen rapidly. Some of the symptoms may include the following:

  • Headaches
  • Loss of balance and coordination
  • Slurred speech, or loss of speech (aphasia)
  • Memory Loss, confusion, disoriented
  • Vision Problems that cause blurred vision or loss of vision
  • Weakness or paralysis of one side of the body
  • Tiredness
  • Seizures

PML Diagnosis

The most accurate way to diagnose PML is by a brain biopsy. But, most brain specialists can diagnose PML by the patient’s clinical symptoms along with a MRI scan, and testing the Cerebrospinal fluid (CSF) for the JC virus. If PML is suspected the Tysabri should be stopped immediately and a clinical evaluation should be performed.

PML Treatment

There is no known cure for PML that is caused by Tysabri. In some cases, the disease may slow or stop once the medication is discontinued, but only if the patient’s immune system improves. The experimental drug treatments used for PML caused by Tysabri have not been very effective. PML is usually fatal and those who do survive the disease are often permanently disabled. Tysabri is intended to help those who suffer from MS or Crohn’s disease that other treatments have been unable to help, but in fact it may actually be fatal instead.

Tysabri PML Lawyer

If you or a family member has been diagnosed with PML, or been treated with Tysabri infusions, contact our law firm to speak to a PML lawyer about your legal options. Every attorney at our law firm is dedicated to fighting for the rights of those that have been harmed by dangerous and recalled drugs and medical devices. For over 25 years, Attorney David Willis has been a trial lawyer representing seriously injured clients in product liability and personal injury lawsuits such as defective drug litigation, class action drug lawsuits and medical device recall lawsuits. If Tysabri has harmed you, or a loved one, contact us right now to discuss your potential case in filing a Tysabri PML Lawsuit with an Attorney.

Darvon, Darvocet Withdrawn in U.S. Over Heart Risks

November 19, 2010, 6:06 PM EST 

By Molly Peterson

(Updates with comment from consumer advocate in the 13th paragraph.)

Nov. 19 (Bloomberg) — Darvon, a 53-year-old pain pill, will be pulled from the U.S. market after a study found potentially fatal heart risks in healthy people who take the medicine at the recommended dose.

Xanodyne Pharmaceuticals Inc., the drug’s owner since 2005, will withdraw Darvon and Darvocet, a product that combines Darvon’s active ingredient with acetaminophen, Food and Drug Administration officials said today in a statement. The agency requested the move after evaluating study data, and asked makers of generic versions to take them off the market as well. Darvon’s active ingredient, the opioid propoxyphene, had been approved in 1957 for treating mild to moderate pain.

The U.K. announced in 2005 that it would pull propoxyphene- containing drugs from the market, citing reports of as many of 400 fatal overdoses a year. The European Medicines Agency recommended a ban last year. Also last year, the FDA rejected an advisory panel’s recommendation to withdraw the drug, opting instead to require a new safety study and a black-box warning label about the risks of excessive use.

Xanodyne’s new clinical research, combined with new epidemiological data, led the FDA to conclude that propoxyphene’s benefits no longer outweigh its risks, said John Jenkins, director of the agency’s Office of New Drugs.

All Users at Risk

The data “suggested that the heart risk of propoxyphene could apply to all users, not just those who took excessive doses or those with medical conditions,” such as reduced kidney function, Jenkins said today during a conference call.

Xanodyne, a closely held drugmaker in Newport, Kentucky, that doesn’t disclose sales figures, acquired Darvon and Darvocet in July 2005 from a company that had bought the rights from Indianapolis-based Eli Lilly & Co., the developer of the medicines.

Xanodyne removed the drug as “part of a market-wide withdrawal applying to all propoxyphene-containing products, affecting branded and generic pharmaceutical companies,” the company said today in a statement. Darvon and Darvocet represent less than 1 percent of the propoxyphene market in total prescriptions, Natasha Giordano, Xanodyne’s chief executive officer, said today in a separate e-mail.

Those two brands “have never been promoted in any way by Xanodyne, neither through personal promotion by sales representatives nor direct-to-consumer or direct-to-doctor advertising or promotions,” Giordano said.

U.S. Prescriptions

About 10 million people in the U.S. received prescriptions for propoxyphene-containing products in 2009, said Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology, on the conference call.

“For the first time, we now have data showing that the standard therapeutic dose of propoxyphene can be harmful to the heart,” he said in the statement.

Users of the drug “need to know that these changes to the heart’s electrical activity are not cumulative,” he said. “Once patients stop taking propoxyphene, the risk will go away.”

Public Citizen will ask Congress to investigate why the FDA didn’t take propoxyphene off the market years ago, said Sidney Wolfe, the Washington-based consumer group’s director of health research.

Wolfe’s group petitioned the FDA in 1978 and in 2006 to ban the drug.

–With assistance from Catherine Larkin in Washington. Editors: Steve Walsh, Andrew Pollack

To contact the reporter on this story: Molly Peterson in Washington at mpeterson9@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net.

The widely prescribed painkillers are linked to serious heart rhythm abnormalities in a new study. Experts say patients and doctors should have little difficulty finding alternatives.

By Andrew Zajac, Tribune Washington Bureau – Los Angeles Times

November 20, 2010

The maker of Darvon and Darvocet announced Friday that it would stop marketing the widely used painkillers in the U.S. because a new study links the active ingredient to serious and sometimes fatal heart rhythm abnormalities.

The FDA requested the withdrawal and urged doctors to stop prescribing the drugs immediately. But it advised patients to keep taking their medication while consulting quickly with physicians to find an alternative. Pain management experts said the drugs are easily replaceable.

The decision follows years of controversy about Darvon’s dangerous side effects.

Sidney Wolfe of Public Citizen’s Health Research Group blasted the FDA’s action as too late and called for congressional hearings into why the agency took so long. Public Citizen tried for more than three decades to limit use of the drug and petitioned the FDA to ban it in 2006.

Known generically as propoxyphene, Darvon is an opioid used to treat mild to moderate pain. Made by Xanodyne Pharmaceuticals Inc. of Newport, Ky., the drug was approved by regulators in 1957. Less than 1% of prescriptions are for the brand name, the company said. The FDA also asked generic manufacturers to stop making it for the U.S. market.

The FDA estimated that propoxyphene was used by 10 million people in 2009, with most of them receiving it in combination with acetaminophen, a compound known by the trade name Darvocet.

Many doctors who prescribe propoxyphene do so simply because it’s been around so long and they’re familiar with it, said Al Anderson, a Minneapolis family practitioner and president of the American Academy of Pain Management board of directors.

Anderson said the withdrawal would hurt a few patients who can’t tolerate other painkillers, but most patients have many alternatives, such as oxycodone, morphine and Nucynta.

“It certainly takes one tool away, but it’s a small tool,” Anderson said.

“We have many better options,” said Mehul Desai, director of pain medicine at George Washington University Hospital in Washington. “It tends to be a pretty poor pain reliever.”

Propoxyphene was effectively pulled from the British and European Union markets earlier because of regulators’ health concerns: Britain in 2005 and the EU in June 2009.

In January 2009, an FDA advisory committee voted 14-12 against continued marketing of propoxyphene. The FDA rejected that recommendation but required a study of the drug’s cardiac effects.

That study showed an increased risk for heart arrhythmias even in healthy patients, not just those weakened by illness.

“We concluded that the pain-relief benefit no longer outweighed the health risks,” said John Jenkins, director of new drugs in the FDA’s Center for Drug Evaluation and Research, in a telephone news conference with reporters.

Wolfe said the FDA should have acted much sooner. Data about heart toxicity was available from an animal study 30 years ago, he said, and at least 1,000 people in the U.S. have died from using propoxyphene since Britain’s 2005 ban.

He labeled the agency’s inaction “a serious indictment of the FDA’s long-lasting unwillingness to protect people in this country from a deadly but barely effective painkiller.”

But judged against its regulatory behavior in recent years, Friday’s announcement continues a harder line on drug safety. It’s the second time in six weeks the FDA has pushed to have a drug removed from the market.

azajac@latimes.com

Copyright © 2010, Los Angeles Times

FDA NEWS RELEASE

 

For Immediate Release: Nov. 19, 2010
Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

Xanodyne agrees to withdraw propoxyphene from the U.S. market

Xanodyne Pharmaceuticals Inc. which makes Darvon and Darvocet, the brand version of the prescription pain medication propoxyphene, has agreed to withdraw the medication from the U.S. market at the request of the U.S. Food and Drug Administration. The FDA has also informed the generic manufacturers of propoxyphene-containing products of Xanodyne’s decision and requested that they voluntarily remove their products as well.

The FDA sought market withdrawal of propoxyphene after receiving new clinical data showing that the drug puts patients at risk of potentially serious or even fatal heart rhythm abnormalities. As a result of these data, combined with other information, including new epidemiological data, the agency concluded that the risks of the medication outweigh the benefits.  

“The FDA is pleased by Xanodyne’s decision to voluntarily remove its products from the U.S. market,” said John Jenkins, M.D., director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research (CDER). “These new heart data significantly alter propoxyphene’s risk-benefit profile. The drug’s effectiveness in reducing pain is no longer enough to outweigh the drug’s serious potential heart risks.”

The FDA is advising health care professionals to stop prescribing propoxyphene to their patients, and patients who are currently taking the drug should contact their health care professional as soon as possible to discuss switching to another pain management therapy.

Propoxyphene is an opioid used to treat mild to moderate pain. First approved by the FDA in 1957, propoxophene is sold by prescription under various names both alone (e.g., Darvon) or in combination with acetaminophen (e.g., Darvocet).

Since 1978, the FDA has received two requests to remove propoxyphene from the market. Until now, the FDA had concluded that the benefits of propoxyphene for pain relief at recommended doses outweighed the safety risks of the drug.

In January 2009, the FDA held an advisory committee meeting to address the efficacy and safety of propoxyphene. After considering the data submitted with the original drug applications for propoxyphene, as well as subsequent medical literature and postmarketing safety databases, the committee voted 14 to 12 against the continued marketing of propoxyphene products. In making this recommendation, the committee noted that additional information about the drug’s cardiac effects would be relevant in weighing its risks and benefits.

In June 2009, the European Medicines Agency (EMEA) recommended that the marketing authorizations for propoxyphene be withdrawn across the European Union. A phased withdrawal of propoxyphene is underway.

In July 2009, the FDA decided to permit continued marketing, but required that a new boxed warning be added to the drug label alerting patients and health care professionals to the risk of a fatal overdose. In addition, the agency required Xanodyne to conduct a new safety study assessing unanswered questions about the effects of propoxyphene on the heart.

The agency now has reviewed the data from that study, which show that, even when taken at recommended doses, propoxyphene causes significant changes to the electrical activity of the heart. These changes, which can be seen on an electrocardiogram (ECG), can increase the risk for serious abnormal heart rhythms that have been linked to serious adverse effects, including sudden death. The available data also indicate that the risk of adverse events for any particular patient (even patients who have taken the drug for many years) is subject to change based on small changes in the health status of the patient, such as dehydration, a change in medications, or decreased kidney function.

“With the new study results, for the first time we now have data showing that the standard therapeutic dose of propoxyphene can be harmful to the heart,” said Gerald Dal Pan, M.D., M.H.S., director of the Office of Surveillance and Epidemiology, CDER. “However, long-time users of the drug need to know that these changes to the heart’s electrical activity are not cumulative. Once patients stop taking propoxyphene, the risk will go away.”

Xanodyne is based in Newport, Ky.

Darvon, Darvocet Banned

Controversial Painkiller Sunk by Dangerous Heart Side Effects

By Daniel J. DeNoon
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 19, 2010 — The FDA has at last banned Darvon, Darvocet, and other brand/generic drugs containing propoxyphene — a safety-plagued painkiller from the 1950s.

New proof of heart side effects, in studies of healthy people taking normal doses of the drug, prompted the FDA to act.

An estimated 10 million Americans are taking Darvocet and other propoxyphene painkillers. They should NOT immediately stop taking the drugs, as there is danger of serious withdrawal symptoms.

Patients taking the drugs should instead immediately contact their doctors for help switching to different methods of pain control.

“Don’t delay,” warns Gerald Dal Pan, MD, MHS, director of the FDA’s office of surveillance and epidemiology.

The FDA action comes nearly six years after the drug was banned in the U.K., and nearly a year and a half after the European drug agency banned it.

The public interest group Public Citizen petitioned the FDA to ban the drug in 1978 and again in 2006. The latter petition caused the FDA to take the matter to an expert advisory committee, which in July 2009 voted 14-12 to ban the drug.

But the FDA overruled the panel, instead asking Darvon/Darvocet maker Xanodyne Pharmaceuticals Inc. to conduct studies of the drug’s effects on the heart. The results of those studies led to the FDA ban.

“The drug puts patients at risk of abnormal or even fatal heart rhythm abnormalities,” John Jenkins, MD, director of the FDA’s office of new drugs at the Center for Drug Evaluation and Research, said at a news conference. “Combined with prior safety data, this altered our risk assessment.”

The FDA ban comes too late for Public Citizen, which blasted the FDA for waiting far too long to protect the public.

“Due to FDA negligence, at least 1,000 to 2,000 or more people in the U.S. have died from using propoxyphene since the time the U.K. ban was announced,” Sidney Wolfe, director of Public Citizen’s health research group, says in a news release.

Wolfe says Public Citizen will call for a congressional investigation into who at the FDA “was responsible for the loss of so many lives in this country.”

Jenkins says although it’s impossible to know exactly how many deaths are linked to propoxyphene, an FDA study shows that more deaths are linked to the drug than to either of two alternative opioid painkillers, tramadol and hydrocodone.

Dal Pan says that people who have taken Darvocet, Darvon, or other propoxyphene drugs for a long time are not at increased risk of heart problems.

“Long-term users should not worry: The heart effects are not cumulative,” he says. “Once people stop using propoxyphene, the side effects should go away.”

More information about the propoxyphene ban is available on the FDA web site — including, for the first time, a video news release.

Darvon, Darvocet and Generic Propoxyphene Withdrawal – Risk of Cardiac Toxicity

 Sold as ISSUE: FDA notified healthcare professionals that Xanodyne Pharmaceuticals has agreed to withdraw propoxyphene, an opioid pain reliever used to treat mild to moderate pain, from the U.S. market at the request of the FDA, due to new data showing that the drug can cause serious toxicity to the heart, even when used at therapeutic doses. FDA concluded that the safety risks of propoxyphene outweigh its benefits for pain relief at recommended doses. FDA requested that the generic manufacturers of propoxyphene-containing products remove their products as well.

BACKGROUND: FDA’s recommendation is based on all available data including data from a new study that evaluated the effects that increasing doses of propoxyphene have on the heart . The results of the new study showed that when propoxyphene was taken at therapeutic doses, there were significant changes to the electrical activity of the heart: prolonged PR interval, widened QRS complex and prolonged QT interval. These changes can increase the risk for serious abnormal heart rhythms.

RECOMMENDATION: FDA recommends that healthcare professionals stop prescribing and dispensing propoxyphene-containing products to patients, contact patients currently taking propoxyphene-containing products and ask them to discontinue the drug, inform patients of the risks associated with propoxyphene, and discuss alternative pain management strategies. Patients were advised to dispose of unused propoxyphene in household trash by following the recommendations outlined in the Federal Drug Disposal Guidelines.

Darvon – Darvocet Heart Toxicity Lawyer

If you or a family member has been diagnosed with Cardiac Toxicity and been prescribed Darvon, Darvocet or generic Propoxyphene, contact our law firm to speak to a Darvon Darvocet lawyer about your legal options. Our law firm is dedicated to fighting for the rights of those that have been harmed by dangerous and recalled drugs and medical devices. For over 25 years, Attorney David Willis has been a trial lawyer representing seriously injured clients in product liability and personal injury lawsuits such as defective drug litigation, class action drug lawsuits and medical device recall lawsuits. If Darvon – Darvocet has harmed you, or a loved one, contact us right now to discuss your potential case in filing a Darvon Darvocet Heart Toxicity Lawsuit.

Warning:  Patients taking Darvon, Darvocet or Generic Propoxyphene HCL, need to be aware of the risk for serious Cardiac Toxicity Side Effects.

 The FDA has warned of a potential increased risk of severe heart toxicity and arythmia issues which in certain cases is serious enough to result in death. Patients taking Darvon, Darvocet or generic Propoxyphene to control pain should be aware of these health risks immediately.

Effective November 19, 2010, the FDA banned Darvon, Darvocet, and other brand/generic drugs containing Propoxyphene HCL. Darvon – Darvocet has been documented to be a safety-plagued painkiller since the 1950s. Recent scientific proof of potentially serious heart toxicity side effects, in studies of healthy people taking normal doses of the drug, has prompted the FDA to finally act.

Darvon, Darvocet and generic Propoxyphene HCL are narcotic analgesic pain-relievers and cough suppressants. Doctors prescribe Darvon, Darvocet or generic Propoxyphene HCL to relieve mild to moderate pain. They work to decrease pain impulses in the brain. An estimated 10 million Americans are currently taking Darvon, Darvocet and other Propoxyphene-based painkillers. It has been advised that patients should NOT immediately stop taking these drugs, as there is danger of serious withdrawal symptoms.

Darvon/Darvocet is also known by the names: Darvon-N, PP-Cap, Balacet, Darvocet A500, Darvocet-N, Darvon Compound 32, Darvon Compound-65, PC-CAP, Propacet, Propoxyphene Compound 65, and Wygesic.

Darvon, Darvocet, Generic Propoxyphene HCL & Cardiac Toxicity

Some patients, despite seemingly proper management by a physician may develop cardiac toxicity and heart damage as the result of being prescribed and taking certain drugs, including  Darvon, Darvocet and generic Propoxyphene HCL. Patients may experience unexplained signs and symptoms such as: Shortness of Breath, Persistent Cough, Loss of Energy, Irregular Heartbeat or even Death.

Speak to a Darvon Darvocet Lawyer

You are not alone. Join other victims of Darvon-related Cardiac Toxicity in speaking up and fighting for their legal rights. Please fill out our free legal evaluation form on the right side of this page and we will call or e-mail you back within 24 hours. Please keep in mind that certain states have a statute of limitations that limits the amount of time you have to file a lawsuit or seek legal action, so don’t wait to contact our law firm. All cases are taken on a Contingency Fee Basis (No fees or expenses are charged to the client by the attorneys, unless there is a recovery made for you.)

 

Department of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research Office of Surveillance and Epidemiology

 
Date: November 19, 2010
Janet Woodcock, MD To: Director, CDER
John Jenkins, MD
Director, Office of New Drugs From: Gerald J. Dal Pan, MD, MHS
Director, Office of Surveillance and Epidemiology Subject: Updated Epidemiological Review of Propoxyphene Safety
Drug Name(s): Propoxyphene Products Application Multiple NDAs and ANDAs Type/Number:
Applicant/sponsor: Xanodyne (NDA Sponsor) and Multiple ANDA Sponsors
Note: This version corrects erroneous footnote numbering in the version signed on 18 November 2010.

 1 Reference ID: 2866332

 

I. INTRODUCTION
 
 This document provides a summary of a review completed in January 2010 by the Office of Surveillance and Epidemiology/Division of Epidemiology (OSE/DEPI) of epidemiological data relating to the safety of propoxyphene drug products. The OSE staff involved in the review included Fatmatta Kuyateh, MD, MS, Medical Officer; Catherine Dormitzer, PhD, MPH, Epidemiologist; Sigal Kaplan, PhD, Team Leader; Cynthia Kornegay, PhD, Team Leader; and Solomon Iyasu, MD, MPH, Director. The review was conducted as part of FDA’s ongoing safety surveillance of propoxyphene drug products following the July 7, 2009 denial of a Citizen Petition filed by Public Citizen in 2006 (the 2006 Petition), which asked the agency to withdraw propoxyphene drug products from the U.S. market on grounds that their risks outweigh their relatively weak benefits as an analgesic.
Based on a comprehensive review of the available evidence, including an advisory committee meeting held in January 2009 (2009 AC), FDA concluded that there was insufficient evidence to support withdrawing propoxyphene from the market at that time, and the 2006 Petition was denied.
 
Following the denial of the 2006 Petition, OSE was asked to review whether certain data sources relied on in the Petition could be re-analyzed, supplemented, and/or expanded to provide further certainty on this point. OSE also was asked to review information in several articles published both before and after FDA’s denial of the 2006 Petition. In January 2010, the OSE reviewers determined that the updated epidemiological evidence favored removal of propoxyphene from the market. The findings of that review are described below.
 
After consideration by a CDER-wide working group and the Drug Safety Board, CDER management decided that, although the updated evidence and analysis strengthened concern regarding propoxyphene,the available data did not provide sufficient evidence to conclude that propoxyphene, at recommended doses, was responsible for the observed findings. Further work was undertaken, including a review of clinical pharmacology and animal toxicology data by Dr. Mark Avigan in OSE, and a final decision was deferred pending review of new clinical evidence from an ongoing study of potential cardiac risks (TQT study), which, at that time, was being conducted by the NDA sponsor, Xanodyne Pharmaceuticals Inc. FDA has now reviewed the results of Xanodyne’s preliminary pharmacokinetic study, conducted to determine appropriate dosing for the TQT study, and has concluded that the data demonstrate a clear, dose-related effect on cardiac electrophysiology. The results of the new TQT study provide evidence that propoxyphene can have an adverse cardiotoxic effect at therapeutic doses. The postmarket signals, including expanded epidemiological analyses, and the findings of Dr. Avigan’s review, are consistent with this conclusion. 
 
 1 In particular, epidemiological evidence relied on in the 2006 Petition was found to be suggestive, but not conclusive, with regard to the Petition’s assertion that propoxyphene has been associated with substantial numbers of non-intentional and intentional deaths. 1
 
 Docket No. FDA-2006-P-0270/PDN (July 7, 2009)
 2 
 
Reference ID: 2866332
This memorandum describes the epidemiological review that was conducted prior to the receipt of the new clinical evidence from the TQT study.
 
After review of the data in this memorandum, a review of clinical pharmacology data and animal toxicology data conducted by Dr. Mark Avigan of OSE, and the electrocardiographic results from the above-referenced TQT study, I conclude that propoxyphene and propoxyphene-containing products should no longer be marketed.
 
II. DISCUSSION
 
This memorandum describes our re-evaluation and updated analyses of epidemiological data and information. These include:
 
At the 2009 Advisory Committee meeting, Dr. Sidney Wolfe presented a report titled “Drugs Identified in Deceased Persons by Florida Medical Examiners” produced by the Florida Department of Law Enforcement (FDLE). He showed a graph of propoxyphenerelated deaths ranging from 328 to 368 for the period of 2003 to 2007. He pointed out that in 2007, 85 (25%) of the 341 propoxyphene-related deaths were caused by propoxyphene. 2008 Medical Examiners Commission Drug Report: http://www.fdle.state.fl.us/Content/getdoc/a37959db85e0-42f9-b6d6-cdef532f22f8/2008DrugReport.aspx
 
 3
  • Florida Medical Examiner Data
  • Data from the Drug Abuse Warning Network (DAWN), including data on emergency department visits (DAWN-ED) and reports of fatalities received from medical examiners or coroners (DAWN-ME/C
  • Suicide Data from England and Wales
  • 1984 Case Study of Severe Propoxyphene Self-Poisoning
  • 1987 Study of Effects of Governmental Warnings
  • Comparative Study of Fatality Rates for Propoxyphene vs. Other Analgesics
  • Case Study of Effects of UK Propoxyphene Withdrawal on Suicide Deaths
  • Additional Information Reviewed by OSE
  • Florida Medical Examiner Data
 
The FDLE releases reports annually titled “Drugs Identified by Florida Medical Examiners”. Through toxicology reports submitted to Florida medical examiners, the FDLE identifies drug-related deaths for which the drug was determined to be the cause of death, or present in the body at the time of death but not causal. A drug is only indicated as the cause of death when, after examining all evidence and the autopsy and toxicology results, the medical examiner determines the drug played a causal role in the death. Multiple drugs can be listed as the cause of death.
 
2 The mortality data presented by Dr. Wolfe were notable but warranted further investigation since these numbers were not to 2Reference ID: 2866332 be put into the context of use, and could not be directly compared to other mortality associated with other opioids.
 
 
OSE/DEPI requested and received similar drug-related mortality data from the FDLE (Table 1). Because the numbers reported at the Advisory Committee meeting were not placed in the context of drug exposure or availability, we could not compare the numbers of deaths to those of other opioids. As a result, OSE/DEPI conducted a more comprehensive analysis of the FDLE data. Information on total prescriptions dispensed was obtained for use as a measure of estimated exposure in Florida. The frequency of deaths was then adjusted for potential exposure by using the number of prescriptions dispensed as the denominator. Two comparator analgesics, tramadol and hydrocodone, were analyzed using the same methods to examine if similar trends of drug-related deaths were found. Tramadol was selected because it has a similar indication to propoxyphene and is currently not a scheduled opioid, so it has a similar level of control to propoxyphene, which is a C-IV level of scheduling. Hydrocodone combination products are scheduled as a C-III, and consequently expected to have more toxicity and higher levels of drug abuse than propoxyphene. Hydrocodone therefore served as a positive control. Hydrocodone also has large sales volume resulting in estimates that are more precise. In addition, tramadol and hydrocodone have been considered possible alternatives to propoxyphene.
 
Table 1 shows, for each drug, the total number of deaths for which the drug was present at time of death, and the number of deaths for which the drug was determined by the medical examiner to be the cause of the death. The number in parentheses is the percentage of the total deaths for which the drug was determined by the medical examiner to be the cause of death.
 
There were 1,740 deaths reported by the Florida Medical Examiners Office where propoxyphene products was either present or causal, 670 deaths for tramadol and 2,963 deaths for hydrocodone products for the years 2003 through 2007. Over this five-year period, propoxyphene was determined to be causal in 26% of the propoxyphene-related deaths. Tramadol was causal in 21% of tramadol-related deaths and hydrocodone in 34% of hydrocodone-related deaths. From 2003 – 2007, there were approximately 11 million prescriptions for propoxyphene, 34 million for hydrocodone and 6.6 million for tramadol. The number of prescriptions dispensed serves as a proxy for the amount of drugs available (or exposure) in the community. Over the five-year period, the number of drug-related deaths adjusted for drug utilization was approximately 16 deaths per 100,000 prescriptions for propoxyphene, 10 deaths per 100,000 prescriptions for tramadol and 9 deaths per 100,000 prescriptions for hydrocodone, the positive control. The number of deaths per 100,000 prescriptions was consistently higher for propoxyphene than the comparator drugs through all five years of data particularly when considered as causal. The two-fold difference in number of drug-caused deaths per 100,000 prescriptions for propoxyphene, compared to tramadol and hydrocodone is noteworthy. The increased ratio of deaths per 100,000 prescriptions associated with propoxyphene strongly suggests greater toxicity when compared to tramadol and hydrocodone. These results provide evidence to support withdrawing propoxyphene from the market.
 
4
 
Reference ID: 2866332    

Table 1: FDLE:  Number of Drug Related Deaths Reported by Florida Medical Examiners, and Dispensed Prescriptions for Propoxyphene, Tramadol and Hydrocodone 2003 -2007, FloridaPropoxyphene     Tramadol    Hydrocodone   
Number of drug-related deaths

  

1,740          

670          

2,963          

Present

 
a

1280          

527          

1964          

Causal

 
b

460 (26%)          

143 (21%)          

910 (33%)          

Number of Prescriptions Dispensed in Florida    10,931,158          

6,608,176          

33,987,828          

Number of Total Deaths

 
c per 100,000 prescriptions
 

15.9          

10.1          

8.7          

Number of Causally-Related Deaths per 100,000 prescriptions    4.2          

2.2          

2.9