Middle-aged men--a risk category regarding fatal poisoning due to dextropropoxyphene and alcohol in combination

Dextropropoxyphene (DXP) toxicity is highly potentiated by alcohol and the aim of this study was to determine the characteristics of non-suicidal deceased with simultaneous occurrence of alcohol and DXP in the blood.

The investigated population was based on the total medico-legal autopsy material in Sweden during the years 1992-1996. Toxicological analyses and death certificates were examined.

Simultaneous occurrence of DXP and alcohol was detected in 425 cases. The mean blood alcohol concentration was 0.14%. One-third had a blood alcohol concentration >;0.20% and 42%, <0.1%. The majority of the cases were found between the ages 30 and 59 years;, 71% were male and 29% were female. Notes on alcoholism were found in 16% of the cases.

Middle-aged, habitual or social-drinking men, on medication for pain, are most prone to combine DXP and alcohol and are most vulnerable to be victims of accidental poisoning due to the combination of DXP and alcohol. We propose strict regulations in prescription, or even a ban on prescription of DXP, and that physicians in the meantime pay extra attention to this risk category of patients and make sure that the patient is well informed of the life-threatening risks of simultaneous use of DXP and alcohol.