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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on January 31, 2005, at 10:16:51
NB. In the US, co-proxamol is available as Darvocet. This information does not apply to the US.
Co-proxamol will soon be discontinued in the UK.
CO-PROXAMOL: OUTCOME OF THE REVIEW OF RISKS AND BENEFITS
1 What is co-proxamol?
Co-proxamol is a prescription only medicine used to treat mild to moderate pain.
It contains a combination of a low dose of paracetamol/acetaminophen (325 milligrams per tablet)
and a painkiller called dextropropoxyphene (propoxyphene). (Ordinary paracetamol tablets
normally contain 500 milligrams). Several pharmaceutical companies market it as
'Co-proxamol' and it is also marketed under the brand names Distalgesic,
Cosalgesic and Dolgesic.2 What is the problem with co-proxamol?
There is little evidence that co-proxamol is more effective in treating pain than
normal paracetamol in the recommended dose. Around 300-400 self-poisoning
deaths each year, of which around a fifth are accidental, involve co-proxamol.
Prescribers are aware of the serious risks to patients who exceed the
recommended dose on co-proxamol. The MHRA has conducted a review of the
risks and benefits of co-proxamol and the Committee on Safety of Medicines
(CSM) has advised that the balance of risks and benefits of co-proxamol is
unfavourable.3 What was the outcome of the review of the use of co-proxamol and
request for information on risk: benefit?The CSM, the independent expert body which advises the government on
medicines, has considered the responses to the public request for further
information on the risks and benefits of co-proxamol. After careful consideration,
the CSM has advised that co-proxamol should be withdrawn from the market on
the grounds that the benefits of taking co-proxamol are not considered to
outweigh the risks.4 If co-proxamol has been available for over 40 years, why has action only
been taken now?Co-proxamol has been marketed since the 1960's, and was firmly established as
a treatment for mild to moderate pain before modern standards of clinical
research. Current evidence is that previous advice in 1985 to strengthen
warnings about co-proxamol overdose has not impacted on the problem.5 When will co-proxamol be withdrawn from the market?
Co-proxamol will be phased out of the market place gradually over 6 - 12 months
to give patients time to discuss their treatment with their doctor and change to a
suitable alternative. There is no need for panic or concern and if patients have
been taking co-proxamol continuously for a long time they should not stop
without consulting their doctor.6 How will patients who use co-proxamol now treat their conditions?
There are a number of options for managing painful conditions and CSM has
recently issued advice. There is no need for urgent medical advice – patients
taking co-proxamol can have the management of their treatment reviewed at their
next routine check.7 If the CSM has advised that co-proxamol should be withdrawn from the
market why is it not being done immediately - is it safe for me to carry on
taking medicines containing co-proxamol until it is no longer available?The CSM advised that co-proxamol should be phased out over a period of time
rather that withdrawn from the market immediately, to give patients currently
taking the medicine time to discuss their medication with their doctor and move to
a suitable alternative. No medicine is absolutely free of possible side-effects. It is
important that you:
• Only take the medicine if it has been prescribed for you
• Always read the patient information leaflet supplied with your medicine
and follow the instructions carefully
• Do not take more than the recommended dose
• Never take it with alcohol, sedatives, tranquillisers or other medicines
containing paracetamol
• Store your medicine out of the sight and reach of children and adolescents
• Destroy any unused tablets or return them to your pharmacist as soon as
possible8 Is it safe to stop co-proxamol straight away? What else can I take?
If you have been taking co-proxamol continuously for a long time, you should not
stop without consulting your doctor. If you only take co-proxamol intermittently,
there is no problem with stopping straight away. Remember to destroy any
unused supplies or return them to the pharmacist as soon as possible. There are
other medicines available with or without prescription that do not contain the
ingredient dextropropoxyphene (DXP). Your pharmacist or doctor can advise you
on the choice available.
Posted by medhed on January 31, 2005, at 10:57:30
In reply to CO-PROXAMOL will soon be discontinued in the UK, posted by ed_uk on January 31, 2005, at 10:16:51
I find that Darvon and Darvocet are not very effective pain killers. This drug is probally one of the easiest narcotics to obtain, yet one of the most toxic in an OD situation. This drug is specifically recommended as a viable self deliverance tool in the Hemlock Society's book "Final Exit".
I do hope you find a substitute that makes you happy though.
Posted by ed_uk on January 31, 2005, at 11:01:05
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by medhed on January 31, 2005, at 10:57:30
>I do hope you find a substitute that makes you happy though.
What do you mean? I don't take co-proxamol.
Ed.
Posted by medhed on January 31, 2005, at 12:54:38
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK » medhed, posted by ed_uk on January 31, 2005, at 11:01:05
I'm sorry, I thought you took it.
Posted by pretty_paints on February 3, 2005, at 2:44:10
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by medhed on January 31, 2005, at 12:54:38
Hi Ed,
Does Co-proximal have any antidepressant effects? I heard something on the news about this, and my great-Auntie (who suffers from bad arthritis) used to take Co-proximal, and said something along those lines too.
She said that she'd take a tablet, then about half an hour later she'd be feeling better in herself, and therefore she could cope with the pain easier. She said it gave her a boost.
Is there really any evidence for this do you know?
She had to eventually stop taking Co-proximal anyway, as it lost it's effectiveness as she kept increasing the dose.
Thanks Ed! Hope you are doing ok?
Kate xx
Posted by ed_uk on February 3, 2005, at 8:38:55
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by pretty_paints on February 3, 2005, at 2:44:10
Hi Katie!
>She said that she'd take a tablet, then about half an hour later she'd be feeling better in herself, and therefore she could cope with the pain easier. She said it gave her a boost.
Co-proxamol contains paracetamol and dextropropoxyphene. Dextropropoxyphene is a low-potency opioid. Some people find opioids euphoric. Morphine, codeine and heroin are common examples of opioids. Dextropropoxyphene is significantly more toxic than morphine, despite the fact that it is much less potent, this is the reason why it is being withdrawn from the market.
>Hope you are doing ok?
I'm not too bad thanks, most lectures have been ok so far. Thanks for asking.
Ed xxx
Posted by TikkiRo on February 3, 2005, at 15:48:03
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by medhed on January 31, 2005, at 10:57:30
Just had someone state this was an easier drug to overdose on than some of the others at only twice the normal dose required to cause problems - is that true? There's less paracetamol in it than some of the other combinations so can't really see how that might be, and don't want to fire a rebuttal without some verification. Thanks.
Posted by ed_uk on February 4, 2005, at 6:48:44
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by TikkiRo on February 3, 2005, at 15:48:03
Hi,
Co-proxamol contains dextropropoxyophene as well as paracetamol. Dextropropoxyphene is highly toxic in overdose, more so that other opioids. The effects of most opioids such as diamorphine can be completely reversed by the antidote naloxone (Narcan) - so long as the patient's brain hasn't been starved of oxygen for too long. Dextropropoxyphene overdose can cause acute heart failure, convulsions and cardiac arrhythmias. These symptoms are not responsive to naloxone. As a result, dextropropoxyphene overdose is commonly fatal because it is very difficult to treat.
Another disadvantage of dextropropoxyphene is its long-acting toxic metabolite. The toxic metabolite can accumulate, especially in the elderly.
Ed.
Posted by TikkiRo on February 4, 2005, at 8:09:51
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK » TikkiRo, posted by ed_uk on February 4, 2005, at 6:48:44
Thanks so much for that info - thought I was reasonably well educated about most of the painkillers, but certainly wasn't aware of the serious dangers of this particular one. Least now I'll not make a fool of myself in posting my reply to the post on my own forum :-))
Regards TR
Posted by ed_uk on February 4, 2005, at 8:21:06
In reply to Re: CO-PROXAMOL will soon be discontinued in the UK, posted by TikkiRo on February 4, 2005, at 8:09:51
Hi,
>Thanks so much for that info.
You're welcome :-)
Ed.
This is the end of the thread.
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