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GPs are being brainwashed over the use of co-proxamol

From Dr Chris Holland,

consultant rheumatologist, Sunderland Royal Hospital

As a consultant rheumatologist with 23 years' experience, there is absolutely no doubt that co-proxamol is an invaluable drug for patients with chronic rheumatic


Its withdrawal has caused enormous distress for a large number of patients who

have found it to be safe, effective and free of many of the side-effects of other analgesics such as

constipation and impaired cognition.

There has been pressure for a couple of years before it was withdrawn for us to stop using co-proxamol on the grounds it was 'no better than paracetamol alone' and concern about the overdose risk.

For acute pain, when co-proxamol has been compared with paracetamol there was no greater benefit. However, there have not been any well-designed either placebo-controlled trials or trials comparing co-proxamol with paracetamol alone for chronic rheumatic pain. To extrapolate from an acute setting to a chronic setting is unscientific and inappropriate in view of the totally different mechanisms involved in chronic pain.

So although it was anecdotal, large numbers of rheumatologists and patients have come to the

conclusion co-proxamol is superior to other simple analgesics.

One has to concede that if taken in overdose, patients are more likely to die than with other simple analgesics. I have no concerns about patients continuing the drug

providing some counselling is given at the onset about the risks.

Although I understand it will be possible to still prescribe co-proxamol on a named-patient basis, the GPs in our area have been totally brainwashed into thinking the drug can never be prescribed and is dangerous and ineffective.

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