Co-proxamol and suicide: Licence needs to be changed

doi:10.1136/bmj.327.7409.287

BMJ 2003;327:287 (2 August), doi:10.1136/bmj.327.7409.287

Letter

Co-proxamol and suicide

Licence needs to be changed

The first 150 words of the full text of this article appear below.

EDITOR—We agree with Hawton et al that co-proxamol presentsa major overdose hazard, their results illustrating the difficulties for licensing authorities in limiting availability of prescriptionmedicines that are only hazardous in overdose.¹

Co-proxamol is more likely to result in death; it causes prolongationof the QRS interval in an electrocardiogram in experimentalanimals and in humans.^{2
3} This property is usually associatedwith sodium channel blockade and is a precursor to ventriculararrhythmia. We have shown a significant relation between estimated dextropropoxyphene dose (based on paracetamol concentration)and QRS prolongation in a case of co-proxamol poisoning,⁴an effect not seen with other opioid combination products.

Dextropropoxyphene is rapidly absorbed from the gastrointestinaltract, increasing early cardiac risk, with death happeningwithin one hour after ingestion.⁵ Most patients probably dieof co-proxamol poisoning as a result of its combined cardiac(non-opioid) and central nervous system (opioid) effects before hospital . . . [Full text of this article]

D N Bateman, reader in clinical pharmacology

nick.bateman@luht.scot.nhs.uk

R Afshari, postgraduate fellow

Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA

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