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CO-PROXAMOL AND SUICIDE: WITHDRAWAL OF A COMMON MEDICATION

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Abstract

 INTRODUCTION: Co-proxamol, a combination of paracetamol and dextropropoxyphene, is a common cause of drug-induced death and hospital admission in the Western World. METHODS: Several studies have been conducted to assess the relative toxicity of co-proxamol in overdose and in particular in comparison to the 2 other paracetamol-opioid combination products, co-codamol and co-dydramol in United Kingdom.RESULTS: We have shown a significant relation between estimated dextropropoxyphene dose (based on paracetamol concentration) and QRS prolongation in a case of co-proxamol poisoning (mean [95% CI] 99.36 [96.19, 102.53] msec). When related to prescription volume overdoses involving co-proxamol in Scotland were 10 times more likely to be fatal (24.6 (19.7, 30.4)) when compared with co-codamol (2.0 (0.88, 4.0)) or co-dydramol (2.4 (0.5, 7.2)).CONCLUSIONS: The excess hazard from co-proxamol is due to inherent toxicity rather than increased use in overdose. We estimate from this study that withdrawal of co-proxamol would prevent 39 excess deaths per annum in Scotland alone. Co-proxamol was withdrawn from the market in the United Kingdom recently partly because of these studies.

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