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Letters to the Editor
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Co-proxamol withdrawal
Withdrawal was an unwise step
From Ms S. Nazmeen, MRPharmS, and others
We think that withdrawal of co-proxamol on the basis of toxicity and alcoholic
potentiation effect on the central nervous system is rather an unwise step.
The problem could have been addressed more appropriately by reclassification
and a much tighter control on prescription writing. This product, which
is relatively inexpensive, has been used for decades and has a well-proven
efficacy.
Recently we conducted a survey about the co-proxamol prescriptions written
in our local area, West Yorkshire. It is heartening to find that in the
past five years the quantity of co-proxamol prescribed dropped between
25 and 75 per cent in some areas. This drop was more visible in casual
prescribing than in repeat prescribing. When prescribers were asked about
co-proxamol preference to other non-opioid or compound analgesics, the
general response from prescribers was that co-proxamol is useful in a variety
of conditions (anxiety, insomnia, dysmenorrhoea and in chronic muscular
or skeletal pain, especially in accidental injuries). Also it is less constipating
than other currently available opioid analgesics.
We agree that abuse of co-proxamol leading to accidental death and alcoholic
potentiation of CNS depression are serious matters. Using analgesics like
co-codamol, co-dydramol, etc, could have the same results if they were
abused. Another problem with these analgesics is their potential to cause
side effects such as constipation, nausea, vomiting and drowsiness.
In our view, the best way to have handled the co-proxamol problem would
have been in the same way as aspirin and paracetamol over-prescribing was
in the past. Smaller quantities, as necessary, could have been prescribed
by doctors, preferably in their own handwriting. Regrettably this might
have increased the workload as far as prescription writing is concerned.
However, this would have been a small sacrifice to make, especially when
one considers the option of controlling pain with a product that has a
well-documented pharmacokinetic profile. The patient could have been counselled
and reminded that extra consumption of the product is extremely dangerous
and any unused stock should be returned to their pharmacy for destruction.
S. Nazmeen
Huddersfield
T. U. Qazi
Halifax
M. Siddique
Bradford |
The
Pharmaceutical Journal