The Pharmaceutical Journal
Vol 270 No 7248 p637
10 May 2003

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Call for reducing the availability of co-proxamol to help prevent high number of drug-related suicides

A call has been made by the Centre for Suicide Research, Oxford, to reduce the availability of co-proxamol. It suggests this could include more careful prescribing and better disposal of unwanted supplies.

New research published this week has found that co-proxamol is the second most commonly prescribed drug used to commit suicide in England and Wales. The call for its restriction is based on the fact that overdoses with co-proxamol appear to be more dangerous than with other drugs.

Professor Keith Hawton, University of Oxford department of psychiatry (where the suicide research centre is based), and colleagues examined the incidence of drug-related suicides and self-poisonings between 1997 and 1999.

Of the 4,162 drug-related suicides that occurred, 22 per cent involved tricyclic antidepressants alone, 18 per cent co-proxamol alone and 9 per cent paracetamol alone. However, the odds of dying after a co-proxamol overdose were significantly higher: 2.3 times that of tricyclic antidepressants and 28.1 times that of paracetamol.

"Reducing the availability of drugs used for suicide can result in a reduction in deaths, and availability of co-proxamol should be restricted," Professor Hawton concludes.

He suggests that clinicians should be aware of the risks of overdose with co-proxamol not only for the patient they are prescribed for but also for other members of the patient's household. "Large quantities should not be prescribed without good reason," he says.

In addition, patients should be instructed to dispose of unwanted supplies.

Professor Hawton suggests that alternatives to co-proxamol should be sought. "Clinicians should consider whether there are other equally effective but less dangerous methods of pain relief, such as combining a safer analgesic with an opiate while maximal relief is required."

A number of factors need to be taken into account when tackling the problem, he says. These include: patients with pain being at increased risk of suicide, the fact that co-proxamol is a prescription-only medicine, the risk of poisoning not being restricted to the person to whom the drug is prescribed, and that a review has shown that co-proxamol is no more effective than paracetamol for short-term pain relief.

The study is published in the BMJ (2003;326:1006).