Co-proxamol and suicide
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7409.287-a (Published 31 July 2003) Cite this as: BMJ 2003;327:287
Co-proxamol should be restricted, not banned
- Ivan L Marples, consultant in pain medicine and anaesthesia (ivan{at}doctors.org.uk)
EDITOR—Smith suggests that co-proxamol be banned.1 I am surprised by this reaction to Hawton et al's paper on co-proxamol and suicide.2 Hawton et al clearly advocate restricting the availability of co-proxamol.
Dextropropoxyphene is closely related to methadone, and like methadone it has noradrenergic analgesic properties in addition to its opioid effect. Patients who attend pain clinics have often tried several compound analgesics, and occasionally they report that co-proxamol is the most effective. This may reflect a neuropathic component to their pain that is quite different to the postoperative pain for which co-proxamol is no better than paracetamol alone.
The evidence suggests that co-proxamol should be restricted perhaps to specialist use but not banned outright. After all a knee jerk ban of thalidomide would have deprived medicine of a drug still used in the treatment of leprosy.
Footnotes
-
Competing interests None declared.