Propoxyphene napsylate compared to methadone for opiate dependence.

When high single doses of propoxyphene napsylate (PN) were given to patients on a methadone maintenance program, results indicated that, to avoid undesirable side effects, the dose should not exceed 600 mg. However, when PN was given in divided doses (800 mg/day in two equal doses), no significant adverse reactions were noted. In the double-blind comparison of 800 mg PN in two divided doses versus 20 mg methadone, 10 mg methadone, or placebo methadone, it was found that PN (1) did not alleviate withdrawal symptoms in patients previously maintained on 20 mg methadone, (2) produced a slightly overmedicated effect in the detoxified group of ex-methadone patients, and (3) compared favorably to 10 mg methadone in suppressing withdrawal symptoms without producing evidence of overmedication in those patients previously stabilized on a methadone maintenance dose of 10 mg. It is concluded that on a mg for mg basis, PN at a dose of 80-times that of methadone will relieve withdrawal symptoms in the treatment of mildly addicted patients requiring 10 mg methadone or less per day.

Choice of rating form for evaluating anxiolytics.

The HAM-A has been a popular tool for assessing the anxiety status of patients. However, when studying anxiolytics, HAM-A presents problems. It includes 89 signs and symptoms grouped under 14 major items. Redundant symptoms appear in several items, and different symptoms under the same item may have variable severity, resulting in inconsistent ratings. In addition, evaluation of all 89 symptoms is time consuming and cumbersome, especially when frequent ratings are required in studying patient response to pharmacotherapy. The WARS was specifically designed to quantify symptoms of anxiety for the study of anxiolytics. It contains 12 one-word items, expressing all the relevant and commonly occurring psychic and somatic symptomatology relevant to anxiety. Symptomatology due to medication is rated separately on a side-effect scale. The WARS is thus more sensitive in detecting therapeutic changes. Because of its simplicity and lack of ambiguity, the WARS can be accurately and effortlessly completed in studying anxiolytics.

Initial methadone dose in treating opiate addiction.

Intramuscular administration of naloxone was used to precipitate the narcotic withdrawal syndrome in opiate-dependent patients. Objective signs of withdrawal were rated according to a previously developed scale. Based upon naloxone-induced withdrawal scores, 76 patients were given a dose of methadone, either low, medium, or high, in a randomized double-blind manner on 2 consecutive days. The adequacy of the methadone dose was evaluated by assessing the patients' physical responses after each treatment. Results indicate that the medium dose of methadone in each naloxone-induced withdrawal score range provides optimal control of narcotic deprivation. It is concluded that a correct initial dose of methadone can be administered when the degree of opiate dependence is established by the naloxone test.

Clinical comparison of propoxyphene napsylate and methadone in the treatment of opiate dependence.

In this double-blind comparison of propoxyphene napsylate (PN) 800 mg in two divided doses versus methadone 20 mg, methadone 10 mg or placebo methadone, it was found that PN: 1) did not alleviate withdrawal symptoms in patients previously maintained on methadone 20 mg; 2) produced a slightly overmedicated effect in the detoxified group of exmethadone patients; and 3) compared favorably to methadone 10 mg in suppressing withdrawal symptoms without producing evidence of overmedication in those patients previously stabilized on a methadone maintenance dose of 10 mg.