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Independents' Day

GPs told by CCGs to find alternatives for co-proxamol prescriptions

Exclusive CCGs are sending letters to GPs telling them to switch prescriptions for co-proxamol to paracetamol because of escalating costs for the drug since it was removed from the Drug Tariff in October.

NHS Nene Valley CCG and NHS Basildon and Brentwood CCGs have told their members to switch patients to alternative medication after fears that the annual spend will far outreach the £3.2 million spent in 2014 on co-proxamol.

The drug has had to be sourced as an unlicensed ‘special’, increasing its costs. 

A review published in 2015 found that the UK annual spend on co-proxamol – a drug known to have a high risk of harms – was £3.2m in England in 2014 and £2.4m could have been saved by switching patients to paracetamol.

The chair of the GPC’s prescribing committee described the amount currently spent on the drug as ‘staggering’, considering it was recommended for withdrawal from the market in 2005.

But the costs have increased after the removal from the Drug Tariff, from £21.38 for 100 tablets to £49.50 now.

Over 100,000 prescriptions for co-proxamol were still being issued in England in 2014, despite the drug being withdrawn from the market in 2005 over safety concerns.

Since becoming unlicensed, all liability for patients continuing to take co-proxamol lies with the prescriber.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said: ‘I am staggered to see [the amount] being spent on co-proxamol which was withdrawn from general sale in 2005 and had marketing authorisation withdrawn shortly afterwards.

‘This is a toxic preparation and most practices stopped all prescribing then, any GP continuing to prescribe does so at great personal risk and would have significant difficulty explaining their actions to a coroner should that be required.’

NHS Nene Valley CCG has stated in its prescription newsletter that spend for their co-proxamol prescriptions will reach in excess of £46,000 by the end of 2016 if patients are not given alternatives.

Meanwhile, a spokesperson for NHS Basildon and Brentwood CCG said the CCG was ’ demonstrating a higher cost associated with co-proxamol prescribing compared to other CCGs in the East of England, and this is an area which the Medicines Management Team are currently looking at closely’.

They added: ’We are just about to remind practices about the safety concerns, lack of evidence and unlicensed status of this product, and recommend that practices review patients prescribed co-proxamol and switch them to an alternative pain management regime.’

Nene CCG was approached for comment but did not respond.


Readers' comments (36)

  • I completely agree. Some suppliers are quoting us in excess of £100 for a box of 100 tablets. Patients unfortunately seem quite attached to co-proxamol for some reason!

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  • Horrid pills, took one once and it wiped me out. Never again....

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  • wonderful drug. useless as an analgesic but makes you not care about the pain.
    I find it really difficult to understand why any Dr is still prescribing this. Maybe there is a use for CQC after all

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  • I've never prescribed it (too young to remember it ;-) BUT GPs can prescribe as they feel appropriate and CCGs should not be telling them what to do. I'm quite sure most of these are not new prescriptions, but rather people who have been on it for years and years

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  • "BUT GPs can prescribe as they feel appropriate and CCGs should not be telling them what to do."

    I have to respectfully disagree. If some of our colleagues are spending £50 of NHS money for what is essentially a box of paracetamol, I think it is appropriate that somebody steps in and tells them to stop.

    A balance must be struck between clinical autonomy and good use of public resources.

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  • Can't say I've ever prescribed it. Perhaps once, some years ago, when patient moving from one drug to next. But TBH there are loads of alternatives to it.

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  • Co-proxy ok is a usefully effective drug without the side effects of the codeine combinations. The safety concerns have been greatly exaggerated

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  • Co-proxamol from personal experience does little for pain but has a significant euphoric effect ( if taken in excess). Similar to dihydrocodeine (euphoria) but more dangerous due to the overdose risks.
    I am now in recovery from addiction.
    I suspect much of the ongoing prescribing is due to patient pressure, "its the only thing i can take". I suspect many of these patients are dependent on co-prox and get withdrawal symptoms when they stop taking them.

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  • We're not talking large numbers of scripts here and I bet most have them have tried other things already. Worry about the big stuff before you move on to marginal gains

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  • BTW presumably as we are all theoretically medical practitioners here, I don't see how these individual case testimonies (I tried it and didn't like it/it made me sick) really helps. That's not good quality evidence, folks.

    Lots of people did take it successfully and lots of people struggled to find a suitable alternative.

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