NPC Archive Item: Time running out for co-proxamol users

NOTE – This is an archive post from the NPC and has not been updated since first publication. Therefore, some hyperlinks may no longer be working.
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Licences for co-proxamol will be cancelled at the end of 2007 – less than two months away. The MHRA has reminded health professionals of this in the latest issue of Drug Safety Update (4th November – see separate blog). After that time co-proxamol will be available only on a “named patient” basis, so, as with all unlicenced drugs, all responsibility will rest solely with the prescriber.

The decision to withdraw co-proxamol from the market was taken in January 2005 due to safety concerns and lack of evidence for efficacy. In January 2007, the MHRA stated:

“Co-proxamol is implicated in 300-400 deaths from overdose a year. There is growing concern prompted by UK research which shows that co-proxamol is implicated in almost one fifth of drug related suicides and is second only to tricyclic antidepressants as an agent of fatal overdose.”

There is no robust evidence that co-proxamol is any more effective than full strength paracetamol for either acute or chronic pain. There is also no identifiable patient group in whom the risk: benefit of co-proxamol is positive.

In May 2006, the NPC published a MeReC Bulletin giving advice and suggestions on management of mild to moderate pain

Action: Prescribers should actively review all patients currently prescribed co-proxamol and make every effort to find an alternative analgesic that meets the patient’s needs, before the licences for co-proxamol are cancelled in a few months time.