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EDITOR--You suggest that Co-proxamol should be banned. I am surprised
by this uncharacteristically ‘tabloid’ reaction to Hawton et al’s paper on
Co-proxamol and suicide. Hawton and colleagues clearly advocate
restricting the availability of Co-proxamol.
Dextropropoxyphene is closely
related to methadone and like methadone it has nor-adrenergic analgesic
properties in addition to its opioid effect. Patients who attend Pain
Clinics have often tried a number of compound analgesics and very
occasionally they report that Co-proxamol is the most effective. This may
reflect a neuropathic component to their pain that is quite different to
the post-operative pain for which Co-proxamol is no better than
paracetamol alone.
I think the evidence suggests that Co-proxamol should
be restricted perhaps to specialist use but not banned outright. After all
a knee jerk ban of thalidomide would have deprived medicine of a drug
still used in the treatment of leprosy.
Competing interests:
None declared
Competing interests:
No competing interests
14 May 2003
Ivan L Marples
Consultant in Pain Medicine and Anaesthesia
Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU
Restrict yes, ban no
EDITOR--You suggest that Co-proxamol should be banned. I am surprised
by this uncharacteristically ‘tabloid’ reaction to Hawton et al’s paper on
Co-proxamol and suicide. Hawton and colleagues clearly advocate
restricting the availability of Co-proxamol.
Dextropropoxyphene is closely
related to methadone and like methadone it has nor-adrenergic analgesic
properties in addition to its opioid effect. Patients who attend Pain
Clinics have often tried a number of compound analgesics and very
occasionally they report that Co-proxamol is the most effective. This may
reflect a neuropathic component to their pain that is quite different to
the post-operative pain for which Co-proxamol is no better than
paracetamol alone.
I think the evidence suggests that Co-proxamol should
be restricted perhaps to specialist use but not banned outright. After all
a knee jerk ban of thalidomide would have deprived medicine of a drug
still used in the treatment of leprosy.
Competing interests:
None declared
Competing interests: No competing interests