Dr Messenger: The argument for co-proxamol
Some patients still have faith in the controversial analgesic, says Dr Messenger
You may well be surprised to hear that some GPs are still prescribing co-proxamol. I’m not. Particularly as I’m one of them.
The trouble is, I can see both sides of the argument. On the one hand, I like to think that my prescribing is rational, cost-effective and evidence-based. And I’m aware that co-proxamol doesn’t score too well on any of these criteria. Plus, there are the potential legal pitfalls and the fact that plenty of analgesic alternatives exist. With the drug being withdrawn from the UK market in 2007 in response to its link with suicide attempts, you would think it would be something of a no-brainer to deny it to patients.
But that ignores the ‘on the other hand’ argument. With some patients, you can plea – using logic, science and even scaremongering – until you’re blue in the face. But they have such utter faith in, and psychological addiction to, their chosen pill that they will not be swayed. They will insist that you continue to prescribe, they don’t care how much it costs the NHS and they will promise not to sue if it all goes pear-shaped.
Besides, those ‘alternatives’ are looking less viable by the day. Paracetamol is not the benign drug we’ve always assumed it to be. Even the weakest co-codamol strength carries dire, restrictive warnings. NSAIDs cause all sorts of problems and often require a proton pump inhibitor (PPI) co-prescription. So what then? Opioids? Pregabalin? Gabapentin? No wonder drug abuse and misuse is escalating.
True, I should have enough gumption to simply say, "enough and no more" to my tiny handful of co-proxamol devotees. But, in reality, when you’re running late, they’ve got numerous other symptoms still to sort, the 10-minute clock is ticking and the waiting room is heaving, it’s hard not to bail out by doing what’s most expedient.
So why doesn’t the Department of Health simply blacklist it?