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Withdrawal of co-proxamol linked to reduction in suicides

Withdrawal of the painkiller co-proxamol from the UK market has led to a major reduction in suicides and accidental poisonings involving the drug, without an increase in deaths from other painkillers, finds research published on today.

Co-proxamol was the most commonly prescribed drug used in suicides and was responsible for 766 deaths between 1997 and 1999 in England and Wales. Concerns about large numbers of fatal poisonings led the Committee on Safety in Medicines to announce in 2005 the phasing out of co-proxamol from use in the UK by the end of 2007. Whether this initiative has been effective and reduced poisoning deaths has not been assessed.

Keith Hawton from the University of Oxford and colleagues used national records to compare the impact of the announcement of co-proxamol withdrawal on prescribing practices and deaths from co-proxamol with other painkillers mostly likely to be used instead of co-proxamol (cocodamol, codeine, codydramol, dihydrocodeine, non-steroid anti-inflammatory drugs) in England and Wales between 1998 and 2007.

Findings showed a steep fall (59%), in the prescribing of co-proxamol following the announcement in 2005, accompanied by significant increases in the prescribing of other painkillers including cocodamol (up by more than 20%), paracetamol (up by more than 13%), and codeine (up by more than 8%).

These changes in prescribing practices were accompanied by a 62% reduction in, or 295 fewer suicides, and 349 fewer deaths when accidental poisonings were included, without an increase in deaths involving other painkillers and prescribed drugs. This, say the authors, shows that concerns about the possible substitution of suicide method involving other painkillers were unfounded.

The findings suggest that the UK initiative has been an effective measure and highlights how regulatory authorities "can have an important public health function, as has been found for measures restricting pack sizes of analgesics sold over the counter," they conclude.