Download Co-Proxamol no prescribing policy statement

Prescribing Policy for Co-proxamol on FP10
North East Essex CCG does not support the prescribing of co-proxamol tablets on FP10 prescriptions for the
management of pain:
Co-proxamol is an analgesic, containing paracetamol 325mg and dextropropoxyphene 32.5mg (a weak opioid).
There is no robust clinical evidence that co-proxamol is more effective than full strength paracetamol in
either acute or chronic use.
There is a risk of addiction and abuse associated with co-proxamol.
Due to safety concerns surrounding fatal intentional and accidental poisoning associated with co-proxamol the
Medicines and Healthcare products Regulatory Agency (MHRA) and Committee on Safety of Medicine (CSM)
decided that the risks of prescribing co-proxamol outweighs its benefits and as a result withdrew co-proxamol
from the UK market between 2005-2007.
In 2011, studies in the USA confirmed that dextropropoxyphene is linked to prolongation of the P-R and Q-T
intervals and widened QRS complexes even at normal therapeutic doses.
Co-proxamol is only available as an unlicensed special in the UK and therefore, all liability for patients
continuing to take co-proxamol lies with the prescriber.
The lethal dose of co-proxamol is relatively low and can be potentiated by alcohol and other CNS depressants.
Death from co-proxamol overdose can occur rapidly, even before hospital treatment can be received. The risk
of dying after co-proxamol overdose is 2.3 times that for tricyclic antidepressants and 28.1 times that for
paracetamol.
The risk of overdose can extend to others in the household of the person for whom the drug is prescribed.
Recommendations:
 Do not initiate co-proxamol
 Reassess the balance of risks and benefits in each patient continuing treatment with co-proxamol,
taking into account other co-prescribed medications and any comorbidity, in the light of the US data.
Remember no patient group has been identified in which the risk: benefit ratio of using co-proxamol is
positive.
References
1. MHRA(2011) ‘(Dextro)propoxyphene: new studies confirm cardiac risks’, Available at: https://www.gov.uk/drug-safety-update/dextro-propoxyphene-new-studies-confirm-cardiac-risks (Accessed: 10 October 2016)
Author: North East Essex Medicines Management Committee
October 2016
Review date: Octobert 2018