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Last Updated: Monday, 31 January, 2005, 09:56 GMT
Painkiller scrapped over suicides
Image of pills
The drug has been linked with suicides
A popular painkiller is being withdrawn from the UK market over concerns about links with suicide.

Co-proxamol, used by thousands for conditions such as back pain, will be phased out over the next year or two.

People do not need to come off the drug yet, and should discuss their treatment with their GP, said the Medicines and Healthcare products Regulatory Agency.

Charities criticised the move saying it left many patients with very few options of effective pain relief.

Suicide risk

The MHRA is sending letters to GPs informing them of the decision.

There is no need for panic or concern.
Chairman of the CSM Professor Gordon Duff

Data shows fatal overdoses due to co-proxamol are the second most frequent means of suicide with prescribed drugs in England and Wales, accounting for up to 400 deaths each year.

The risk of death associated with co-proxamol overdose seems to be higher than for either tricyclic antidepressants or paracetamol.

The drug is a combination analgesic containing paracetamol and the opioid dextropropoxyphene and is available only with a prescription.

But some say co-proxamol is no better than full strength paracetamol at relieving pain and is known to be very toxic in overdose.

For this reason, the Committee on Safety of Medicines, an independent expert body that advises the government on medicines, was asked to look at the risks and benefits of co-proxamol.

Bad news

Measures have already been taken to address concerns about the medicine, including making advice more prominent on the packaging.

But they have failed to reduce the number of fatalities, according to experts.

Chairman of the CSM Professor Gordon Duff said: "Co-proxamol will be phased out of the market place gradually 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."

Neil Betteridge, of Arthritis Care, said the move was bad news for people with arthritis, particularly given the recent safety concerns about other painkillers such as COX-2 inhibitors.

"The withdrawal of co-proxamol leaves many people with very few options for the safe and effective management of their pain.

"Although we understand the MHRA's concern, we are of the view that a stringent package of prescribing advice, packaging changes and other warnings should limit the risks of co-proxamol being misused," he said.

A spokeswoman from the Arthritis Research Campaign said: "Co-proxamol is a very effective and much safer than some of the other painkillers.

"It's incredibly bad news."

It is estimated that 1.7 million GP patients per year receive 7.5 million prescriptions for co-proxamol.

Your views:

As a member of the HM Forces with 31 years service I have been prescribed Co-proxomol for a number of years for severe back pain. Earlier last year "Vioxx" was withdrawn, which was prescribed for the arthritic development of my back injuries. Now I will be left with little relief for the pain I have suffered through the wear and tear of military service since pre-Falklands campaign. A review of pain management, without Co-proxomol, may now prevent me completing a full 35 year career. The risk must surely be the decision of the GP.
Frank, Nottingham UK

Co-proxamol cause respiratory depression in even mild overdose, resulting in death. I was trained not to prescribe it for this reason back in the 80s. Over the last 20 years I have personally seen several unnecessary deaths from it. I shall be glad when it is gone.
GP in Telford, Telford Shropshire

This is terrible news for patients with chronic conditions i.e arthritis following the recent withdrawal of COX2 inhibitors. Co Proxamol is certainly a lot more effective than Paracetamol in patients with chronic pain. Of course the last possible drugs to change patients to are codein based drugs i.e Co-Codamol and Co-Dydramol. Following the withdrawal of Co-Proxamol they will predictably lead the suicide tables in the future and will then also get withdrawn.

Arthritis sufferers often take 8 tablets per day, more than 200 per month. Limiting prescriptions to low numbers of any pain killer to prevent suicide in few may mean patients have to come to the surgery every few days and doctors have to sign prescriptions every few days.On the other hand people determined to commit suicide will find other means to do so.
Dr M K, Windsor

It has great brand loyalty with some patients
Robert U, Darlington England

Co-proxamol certainly has been popular with patients although scientific studies have repeatedly failed to demonstrate a significant benefit over other painkillers. I think the problem with co-proxamol is not that it is an effective agent for deliberate suicide, I take the point that if you're going to do it then probably you'll find a way, but accidental death. In combination with alcohol in particular the lethal dose is alarmingly small and much less than with other equally effective painkillers. As GPs we've been trying to get the number of people on this medication down. However, for reasons that are hard to explain in purely scientific terms it has great brand loyalty with some patients. But I think the risk of someone killing themselves, especially unintentionally, with this medication is too high and I applaud the regulatory authorities for taking this action.
Robert U, Darlington England

I find co-proxamol far more effective at pain relief than plain paracetemol. I do not intend to misuse it. I cannot see why I should be deprived of its beneficial effects, because some people might use it for suicidal purposes. If they are intent on suicide, there are plenty of other available drugs to do the job anyway.
John Samuel, Sidcup, Kent,, UK

This is a totally nonsensical decision taken by our 'nannying' masters citing grounds that many will find derisory when we all know that anyone contemplating suicide could do so quite easily by using similar drugs.I have been taking Co-proxamol for over 10 years to effectively alleviate back pain that no other drug seemed to be able to do. I don't know quite how this excellent drug will be replaced for my particular condition.
Mrs B.E.B, Marlborough, England

There's still a multitude of choice out there, there is no need to fuss. What about co-codamol or co-dydramol they are both just as effective without any such fears - not to mention stronger drugs like tramadol. The last thing we need is another media circus about this
Ben Morton, Manchester, England

I have used co-proxamol for many years to manage my back pain. I have tried other pain relievers all of which have given me various nasty side effects, this along with the fact that I am allergic to aspirin means I have very few options open to me. If I can no longer get co-proxamol and cannot find a suitable alternative, it will affect my quality of life and may even lead to me having time work sick with back pain(something that I have managed to avoid in the past).
Sam, Derbyshire, England

C0-proxamol is a nasty drug which should have been taken off the market years ago. Ten tablets can be a fatal dose, and the overdose is difficult to treat because of the respiratory depressant effects of the dextropopoxyphene component.The truly frightening thing about this medicine is the paradoxical reaction, leading to sudden death, if the drug is taken with alcohol.Good riddance.
Jim McKie, Livingston, Scotland

I have been taking Co-Proxamol for about 5 years now for back pain. I do not abuse this medication and only take them when necessary but my body accepts this painkiller with no side effects which is quite rare for me. It is productive in that it works and does not make me drowsy. I shall be concerned now that I will have to eventually 'try out' other drugs to find one that will work efficiently.
I do sympathise with those people who attempt or succeed in taking their lives but I would have thought that they will find an alternative drug to do so and that taking this drug off the market will not bring down the statistics.
Rita Bridgman, Essex, UK

This is bad news for patients and reduces choice
Jason Powell, Fife, Scotland
This is bad news for patients and reduces choice. I have a chronic illness and co-proxamol was found to be the most effective pain killer to control the pain, seeing paracetamol has little effect and I am not allowed to take an asprin based drug. I am sure there will be lots of people in the same situation who basically will have to go back to square one again and find effective pain relief. The risk of suicide might be increased but surely there would be an underlying mental health problem for a person to contemplate this, and if they are determined they could use any number of other "safer" drugs such as paracetamol it's self.
Jason Powell, Fife, Scotland

Any tablet taken in doses higher than those prescribed could kill. Is all medication to be withdrawn? Or perhaps each dose handed out as required as in hospital? This is a typical knee-jerk reaction, and I write as someone who works in health (NOT a drug company I hasten to add)! Co-proxamol taken in the correct doses as prescribed by your doctor is safe. As few as 9 paracetamol tablets can cause permanent and potentially fatal damage to one's liver - shall we ban these too?
Polly S, Lichfield UK

In my 20 years experience as a GP, Co-proxamol is certainly more effective than full dose paracetamol at relieving pain. Once removed from the market, patients will then resort to one of its many cousins, which will then become the next most common cause of suicide deaths! I wonder: could one dare to call it conspiracy?
A GP in Sevenoaks, Sevenoaks, England

If someone wants to overdose they will do it regardless
Lisa Lyons-Wilson, London

If someone wants to overdose they will do it regardless.Withdrawing the drug is paramount to treating us like naughty school children.What about all those that responsibly use the drug and benefit vastly from it?As it is a prescription drug, are there not enough checks in place to try and avoid it being prescribed to those who have suicidal tendencies?

Shouldn't the onus be put on GP's to take a little more care when prescribing this drug, rather then withdrawing it from mass use? Whoever came up with this plan has too much time on their hands.
Lisa Lyons-Wilson, London

I take Co-Proxamol tablets (and have been doing for many years). They are far more effective at relieving pain than ordinary Paracetamols. Surely if a person is hell bent on committing suicide then they will do so by any means available not just by taking Co-proxamol. This appears to be just another case of people been wrapped in cotton wool by the nanny state!
Julie Neale, Bradford, England

Nothing else helps with my pain and they have the audacity to tell me I can no longer have this as a pain reliever. Perhaps offering the tablets in strips of 8 instead of 10 (8 being the maximum per day dosage) would help people remember whether or not they have reached their limit. Those who want to overdose can do so as easily on over the counter paracetamol anyway. Co-proxomol has that one extra ingredient which seems to work for me. But then I can still count.
Liz, London, England

Why the decision to withdraw the drug was made


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