Co-Proxamol Withdrawal
Dear colleague,
As promised, here is the substance of the MHRA information from their
website http://www.mhra.gov.uk/ regarding
co-proxamol with the PDFs from the site attached.
As it states the withdrawal will occur over 6-12 months, so no need to call
in all your patients immediately. I believe that there will be more detailed
guidance soon, but this bare minimum has been published now due to the leak
getting to the press prior to the intended launch date.
- In the meantime, I would suggest
- First line - Paracetamol as an alternative, regular doses may be more
effective than prn dosing.
- Second line - An NSAID
- - Consider addition of a weak opioid such as 30mg codeine prn (as
separate tablets)
- - Only consider combined preparations if concordance is difficult
or a stable consistent usage of both agents is demonstrated.
- - Remember co-codamol 8/500 has no benefit over 500mg paracetamol.
Do not consider either COX-2 inhibitors, effervescent preparations or
Tramacet as alternatives.
BNF No. 48 says (p216): (paraphrased)
Combining a non-opioid with an opioid analgesic can provide greater relief
of pain than a non-opioid analgesic alone. However, this applies only when
an appropriate dose combination is used. Most combination analgesic
preparations have not been shown to provide greater relief of pain than an
adequate dose of the non-opioid component given alone. Moreover, combination
products have the disadvantage of an increased number of side effects.
Full details are included in the attached drug evaluations
I hope you find this timely and useful.
Best wishes
Andrew White
Clinical Effectiveness Pharmacist
Bolton PCT
Tel:- 01204 907745
Fax:- 01204 907750
andrew.white@bolton.nhs.uk
