Items which should not routinely be prescribed in primary care - co-proxamol

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Cost of co-proxamol per 1000 patients
Why it matters

NHS England guidance states:

The Medicines and Healthcare products Regulatory Agency (MHRA) fully withdrew the painkiller co-proxamol from the UK market in 2007 due to safety concerns. All use in the UK is now on an unlicensed basis. Prescribing an unlicensed medicine should be in line with General Medical Council (GMC) guidance, which states suitably licensed alternatives need to be considered and the prescriber must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy.

Since 1985 advice aimed at the reduction of co-proxamol toxicity and fatal overdose has been provided, but this was not effective and resulted in withdrawal of co-proxamol by the MHRA. In 2011 MHRA reported that the withdrawal of co-proxamol from the UK had saved an estimated 300 to 400 lives each year from self-poisoning, around a fifth of which would have been accidental. Since the withdrawal, further safety concerns have been raised, resulting in co-proxamol being withdrawn in other countries.

Due to the significant safety concerns, the joint clinical working group considered co-proxamol suitable for inclusion in this guidance. Co-proxamol is no longer manufactured or supplied in the UK and any use on an unlicensed basis requires it to be imported for individual use, at an increasing cost to the NHS and the environment. The average cost per item is £265 (January 2022), which is an increase of £44 since 2021.

NHS England recommend that GPs:

  • Do not initiate.
  • Deprescribe in patients currently prescribed this medicine.
Tags Cost Saving, NHS England - items which should not routinely be prescribed in primary care, Pain, Safety
Implies cost savings Yes
Authored by richard.croker
Checked by christopher.wood
Last reviewed 2023-09-12
Next review due 2025-09-12
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(actual_cost) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0407010Q0AAAAAA", "0407010Q0AAADAD")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_list_size / 1000.0) AS denominator
 FROM hscic.practice_statistics
 GROUP BY month, practice_id
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