coproxamol

[Fleegle]

Is dextropropoxyphene as 'Doloxene' still prescribable on an FP10? (it's been a long time since I dispensed it).

Fleeg.

[bobbin]

Is dextropropoxyphene as 'Doloxene' still prescribable on an FP10? (it's been a long time since I dispensed it).

Fleeg.

It has been discontinued in the UK. I believe that dextropropoxyphene caps are still marketed in some countries though.

[Geoff Powers]

24 hours later....another thought!

The more I dwell on the problem of co-proxamol's imminent withdrawal and the largish number of individuals who are dependant on it, the more I think that some form of class action in the courts might be a line to take. Expensive probably, but the medical authorities, heath trusts and pharmaceutical companies now have a long record of being challenged in the courts. Why not on this issue too?

It would require a minimum of 100-200 people with very well-documented medical histories and some sympathetic medical lawyers-cum practitioners (perhaps from within the ranks of the medical charities) who know the history of the pharmacology of co-proxamol and who, despite the recorded dangers of the drug, realise and appreciate its obvious benefits for the 10% of chronic pain suffereres who have been prescribed this medication and for whom other 'medicinal compounds' are ineffective.

I would be the first to put my name forward!

Feedback please......

[bobbin]

there is every indication that this time the Department of Health, WHO, etc. mean business and will come down like a ton of bricks on GPs who continue to prescribe, and pharmacists who hold stocks of co-proxamol

Any pharmacy in England can choose to stock co-proxamol if they want to, but many will choose not to because it is no longer frequently prescribed in most areas. The Department of Health and the MHRA do not place any restrictions on stocking co-proxamol. It remains readily available for pharmacies to order as an 'unlicensed special' from either Clinigen or Lexon. Although your pharmacy may not already have an account with either of these suppliers it is very easy to set one up. Clinigen offers a next-day delivery service.....not sure about Lexon. Co-proxamol is not generally available for pharmacists to order from their usual wholesalers unless they still have 'old stock' back from when co-proxamol was licensed. Any pharmacist who claims that they can't get hold of co-proxamol anymore obviously hasn't telephoned the correct suppliers. Clinigen is 01283 494 340 and Lexon is 0800 138 3117.

Since the end of 2007, co-proxamol has been an unlicensed drug in the UK. This does not mean that it has been 'banned'. It remains perfectly legal for doctors to prescribe unlicensed drugs such as co-proxamol and for pharmacists to dispense them but the prescribing doctor is considered to be personally responsible for any harm which may occur as a result of prescribing the drug. Because of this, doctors have been advised by their insurers not to prescribe co-proxamol (in order to avoid any legal problems which may occur if the patient overdoses or suffers a serious adverse reaction). Similarly, PCTs have advised doctors not to prescribe. Ultimately however, any doctor has the right to prescribe co-proxamol if they are willing to take full responsibility for doing so.

Co-proxamol is available either on an NHS prescription from an NHS doctor eg. your GP.......or on a private prescription from a private doctor. If co-proxamol is purchased on a private prescription is it likely to be very expensive. It is no longer produced by a large number of different manufacturers and this has created a lack of competition. Orders for co-proxamol are also normally subject to a delivery charge which further increases the cost.

Bobbin

[bobbin]

The more I dwell on the problem of co-proxamol's imminent withdrawal

Although co-proxamol's license (marketing authorisation) was withdrawn in the UK at the end of 2007, it is still being manufactured as an unlicensed product and will remain available to pharmacies in the UK for the foreseeable future.

The MHRA, the authority which regulates medicines in the UK, has made the following statement.........(on 25th June 2009).....

'The MHRA does recognise that there is a small group of patients who have found it very difficult to change from co-proxamol, when alternatives appear not to be effective or suitable. We have worked with the manufacturer to ensure some unlicensed product remains available. As with any unlicensed medicine there is a provision for the supply of unlicensed co-proxamol, on the responsibility of the prescriber, who can judge the risks and benefits in consultation with the patient.'

The recent announcement by the European Medicines Agency that the licenses for co-proxamol will be withdrawn throughout Europe doesn't affect the UK because co-proxamol's product license has already been withdrawn here.

Bobbin

[Geoff Powers]

Thanks for your comments.

While I would not for one moment wish to challenge your credentials, the situation you describe is, in my own recent experience, descriptive rather of a 'theoretical' situation that existed maybe 12-18 months ago. It certainly does not match what my local pharmacist has told me within the past few days.

In my locality there is absolutely no doubt that the PCT is putting pressure on both GPs and phamacists not to prescribe/stock co-proxamol AT ALL, as evidenced by the 'panicked' reaction of my GP's dispensary staff when they came to process my repeat prescription last week and telephoned me to explain why my co-proxamol was being immediately withdrawn. 'We are not allowed to prescribe this drug any longer'. Have they been misinformed?

My earlier description is reflected also in comments I have read on line from other areas of the UK, including Scotland.

GP

[johnep]

There will come a time when the demand is so low as to be uneconomic to manufacture. At that point pts will have to try something else. I am not sure of the nearest equivalent, but use of Tramadol has soared as co-prox declined.
johnep

[DavidS]

There will come a time when the demand is so low as to be uneconomic to manufacture.

Given the current system, it will never be uneconomic to manufacture, but perhaps the GP's have realised that its becoming expensive, hence uneconomic, to prescribe .....

[Geoff Powers]

Tramadol is one of the 'substitute' medications I trialled over 3-4 months in late 2007.

Similar to my experiences with co-codamol and co-dydramol, after just three doses of tramadol I became severely constipated and was unable to pass anything very much for the next 3-4 days. So for me tramadol does not appear to be a viable alternative except as a very short-term emergency measure. It's not the sort of stuff I would want to go away on holiday with, for example.

Why do these analgesics have to upset the gut so in a small minority of patients? Surely phamaceutical companies should by now been able to formulate medication that does not 'penalise' this minority 10% of patients like myself, whose particular genetic make up appears to be responsible for a range of adverse reactions?

[bobbin]

There will come a time when the demand is so low as to be uneconomic to manufacture.

I don't think that will happen for quite a while. MEDA charge a lot of money for their co-proxamol which probably makes it surprisingly economic. Current list price is £21.38 for 100 tabs.