Distalgesic, Cosalgesic and Dextrogesic (dextropropoxyphene 32.5 mg + paracetamol 325 mg) are still widely prescribed and promoted although they have few advantages and several disadvantages in comparison with paracetamol alone. As has often been pointed out, combination drugs should be used only if each component is necessary for the desired effect, and if the advantage over use of a single drug outweighs the added risk of using two or more.1 In 1978 we drew attention to the need to balance the substantial risks against the limited benefits of using Distalgesic.2 Since then there has been some decrease in Distalgesic prescribing, but about 5 million prescriptions for this drug are still written each year and patients are still coming to harm.
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