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Co-proxamol and suicide: a study of national mortality statistics and local non-fatal self poisonings

BMJ 2003; 326 doi: (Published 10 May 2003) Cite this as: BMJ 2003;326:1006
  1. Keith Hawton (keith.hawton{at}, professor of psychiatrya,
  2. Sue Simkin, researcher and coordinatora,
  3. Jonathan Deeks, senior medical statisticianb
  1. a Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX
  2. b Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF
  1. Correspondence to: K Hawton
  • Accepted 5 March 2003


Objectives: To examine the incidence of suicides due to co-proxamol compared with tricyclic antidepressants and paracetamol, and to compare fatality rates for self poisonings with these drugs.

Design: Analysis of routinely collected national and local data on suicides and self poisonings.

Setting: Records of suicides in England and Wales 1997-9; non-fatal self poisonings in Oxford District 1997-9.

Data sources: Office for National Statistics and Oxford monitoring system for attempted suicide.

Main outcome measures: Incidence of suicides with co-proxamol or tricyclic antidepressants or paracetamol. Ratios of fatal to non-fatal self poisonings.

Results: Co-proxamol alone accounted for 5% of all suicides. Of 4162 drug related suicides, 18% (766) involved co-proxamol alone, 22% (927) tricyclic antidepressants alone, and 9% (368) paracetamol alone. A higher proportion of suicides in the 10-24 year age group were due to co-proxamol than in the other age groups. The odds of dying after overdose with co-proxamol was 2.3 times (95% confidence interval 2.1 to 2.5) that for tricyclic antidepressants and 28.1 times (24.9 to 32.9) that for paracetamol.

Conclusions: Self poisoning with co-proxamol is particularly dangerous and contributes substantially to drug related suicides. Restricting availability of co-proxamol could have an important role in suicide prevention.

What is already known on this topic

What is already known on this topic Co-proxamol is dangerous in overdose

Restricting availability of specific means of suicide can reduce deaths

What this study adds

What this study adds Fatal overdoses due to co-proxamol are the second most frequent means of suicide with prescribed drugs in England and Wales

The risk of death associated with co-proxamol overdose seems to be higher than for either tricyclic antidepressants or paracetamol


  • Funding South East Region NHSE Research and Development Committee. KH is also supported by Oxfordshire Mental Healthcare NHS Trust. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

  • Accepted 5 March 2003
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