coproxamol

[bobbin]

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came to process my repeat prescription last week and telephoned me to explain why my co-proxamol was being immediately withdrawn.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

Well.........I still dispense co-proxamol relatively frequently and have had no difficulty in obtaining it from suppliers. It is delivered with a courier on a next-day basis. Any pharmacist who claims that they can't obtain it probably hasn't telephoned the correct supplier.

Doctors are indeed allowed to prescribe co-proxamol if they want to........although most will not want to because of the risk of getting sued if the patient took an overdose. PCTs and insurers have therefore *advised* GPs not to prescribe - but they retain the right to do so if they wish. Doctors are well within their rights to prescribe unlicensed medicines if they feel that it is clinically appropriate and are willing to take full responsibility for doing so.

[Chirpy]

I second that Bobbin. We get a monthly phone-call from our co-prox supplier asking us how much we need but can always place more. It is your surgery that is having the difficulty. You need a renegade doctor who refuses to toe the PCT line. There are plenty of them around! They are usually the single doctor practices. Acting as a complete law unto themselves is not always a good thing but use it to your advantage!

[bobbin]

We get a monthly phone-call from our co-prox supplier asking us how much we need but can always place more.

Same here.

[Poppy]

Bobbin......... Is £21.38 for a 100 tabs a wholesale price as I was quoted £32 odd the other day?

[johnep]

Sounds about right. Pharmacy markup is 50% on trade.
This compares with 100% for clothing. With fast food restaurant, ie a burger, markup is 2.5 x cost. Ie burger costing MacDonalds 40p would be sold for 100p.
johnep

[Chirpy]

Bobbin......... Is £21.38 for a 100 tabs a wholesale price as I was quoted £32 odd the other day?

Yes - this is the reimbursement rate for this particular drug from the NHS at present. It is an approximation of the price that it can be obtained for. There will be mark-up on this for a private prescription (the NHS pays additional charges such as container fee / dispensing fee / professional service fee etc etc as well as this reimbursement rate) Because Co-prox is not available from the usual wholesalers there may also be a delivery charge in this price. It sounds roughly right.

[bobbin]

Bobbin......... Is £21.38 for a 100 tabs a wholesale price as I was quoted £32 odd the other day?

£21.38 is the manufacturer's price for 100 tablets (Distalgesic brand). The pharmacy may receive a discount off this price but they might also have to pay a delivery charge. Delivery charges can be quite substantial. If a pharmacy supplied 100 tabs (on a private prescription) for £32 they would probably make a profit of a few pounds.

Bobbin

[Poppy]

I found a pharmacy in Birmingham who give an online service and their price is £22.74 so have ordered from them.

[bobbin]

I found a pharmacy in Birmingham who give an online service and their price is £22.74 so have ordered from them.

Oh right, I guess they're not paying for delivery.

[Sir_Dispensalot]

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?

Just to analogise a little. When a software company writes a pc game they have to program it to work on as wide a pc base as possible, as everyone has their pc set up slightly differently. Once a game has gone 'gold' and been released, there is normally a frantic 6months or so of patching the game to get it to work properly on systems where the software refuses to run. This is because the programmers cannot anticipate the sheer number of potential configurations of systems they will sell their product to.

Now, take the human body. Broadly speaking, we more or less are the same layout as each other, but our genetic makeup is so varied that it makes the number of possible pc combinations in comparison laughably small.
When a drug company releases a drug after trials, they hit the same problems as the software programmers. There are bound to be some 'incompatible systems'.
The only difference is that the drug companies can't go out and patch a drug. That and it will have cost billions to research and develop the initial drug - something they would be rather keen to recoup.

Another thing to consider is that the human body often co-opts similar systems for different uses - for example, cell receptors in your lungs look remarkably similar to ones lining your vascular system. This can lead to a targeted drug having unwanted effects in other parts of the body.
In the case of opiate painkillers, they happen to affect the muscle tone of the bowel as well as acting as a painkiller. This is unfortunate but unavoidable as the cell receptors share a very similar shape.
Many people who take opiate painkillers long term have to add in extra drugs such as stimulant laxatives in order to help overcome the constipation side effect. Some also find that this side effect gradually settles down after a few weeks.

And finally, did you consider that your holiday diet change could have had something to do with your constipation too? I often get an altered bowel habit whilst away (can go either way) simply due to me eating foods i wouldn't normally eat and a change in climate. Couple that with a slight decrease in your muscle tone in your bowel due to the painkiller & you might get strain city...