UK. Due to the established toxicity in overdose and poorly defined clinical value of the pain reliever dextropropoxyphene/paracetamol (Co-proxamol), the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK is reminding physicians to observe the following:

• restrict the number of tablets prescribed and avoid prescribing dextropropoxyphene/ paracetamol (Co-proxamol) to patients at risk of self-poisoning or with a history of alcohol abuse

• advise patients that the medication is for their use only and can be dangerous when taken with alcohol or central nervous system (CNS) depressants and that unused tablets should be destroyed or returned to a pharmacy

• inform patients that they should receive a patient information leaflet and ask for one if they do not

According to the MHRA the rationale for the extensive use of the combination of dextropropoxyphene (32.5mg) and paracetamol (325mg) (Co-proxamol) is not evidence based; dextropropoxyphene is a weak analgesic and combining it with paracetamol has not been shown to have greater efficacy than full strength paracetamol. This combination product (Co-proxamol) is currently under review and is the subject of a public request for information.

Reference:

Medicines and Healthcare products Regulatory Agency (MHRA) News, 30 June 2004. Available on the Internet at www.mhra.gov.uk