CO-PROXAMOL
• I
n Jan 2005, MHRA advised to stop using •
Co-proxamol use declined significantly at this time
co-proxamol due to linked high fatality rates
(Figure 2) and was replaced with alternative
involving both intentional and accidental overdose.
paracetamol and opioid combination analgesics with
similar painkilling effect.
Figure 2: Changes in North Staffordshire co-proxamol and combination analgesic prescribing 2002-2009
quarter
moderate analgesics
moderate analgesics excl. coproxamol
coproxamol
Moderate analgesics include codeine 15mg, nefopam, buprenorphine (200mcg tablets or 5 -10mcg/hr
patches), dihydrocodeine 20mg alone or in combination with paracetamol.
TOPICAL NSAIDs
• I n Feb 2008, NICE osteoarthritis (OA) guidelines
encouraged topical NSAID use.
• T
he upward trend in prescriptions of topical NSAIDs
prior to 2008 increased significantly after the
guidelines were published (Figure 3).
Figure 3: Changes in North Staffordshire topical NSAID prescribing 2002-2009
quarter
topical NSAIDS
Safe prescribing is achievable if key guidance is integrated into local prescribing policy.
Useful links: MHRA (www.mhra.gov.uk/); NICE OA Guidelines (www.nice.org.uk/cg59)
All figures reproduced with permission from Bedson J et al. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009:
an observational database study, European Journal of Pain, 2013;17:434-443.
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