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Experts call for diclofenac to be withdrawn due to heart risks

Published on 13 February 2013
Experts call for diclofenac to be withdrawn due to heart risks

The painkiller diclofenac - which is used widely in the UK in people with arthritis - should have its marketing authorisations revoked because of the risks it poses to cardiovascular health, experts have claimed.

Diclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs), which are used to treat pain, fever and - when used in higher doses - inflammation.

It has long been known to increase the risk of cardiovascular complications to a greater extent than other NSAIDs, but new research in the journal PLoS Medicine shows it is still widely used.

Researchers at Barts and the London School of Medicine and Dentistry in the UK and the University of Toronto in Canada looked at the essential medicines lists of 100 countries and found that 74 still feature diclofenac.

In contrast, just 27 countries list naproxen - a much safer alternative - as an essential medicine.

Diclofenac is in fact the most commonly used NSAID in 15 countries, despite its links with heart attacks and strokes in vulnerable patients.

The added risk is similar to that seen with the drug rofecoxib (Vioxx), an NSAID that has already been withdrawn from the market due to safety concerns, say the researchers.

The fact that diclofenac is still so widely prescribed shows that evidence about its risks for cardiovascular health has not been translated into clinical practice.

Dr Patricia McGettigan, from Barts and the London School of Medicine and Dentistry, pointed out that the drug "has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage".

She concluded: "There are strong arguments to revoke its marketing authorisations globally."

A spokesperson from Arthritis Research UK said: "The risks of long-term NSAID use, including taking the drug diclofenac, are well-documented, in particular the increased risk of heart attacks, strokes and gastro-intestinal problems. Unfortunately, other than paracetamol and opiate-based drugs, there are few other effective forms of oral pain relief for people with long-term painful conditions such as arthritis, so it's a case of matching the risks against the benefits.

"We recommend that people take the lowest dose of the most appropriate NSAID for the shortest amount of time to control their pain. The oral NSAID naproxen is generally felt to be the least harmful NSAID in circumstances where people are concerned about a heart condition, high blood pressure or uncontrolled high cholesterol.

"A safer alternative to oral NSAIDs are topical NSAIDs, which come in the form of creams and gels and can be applied directly to the painful joint. If anyone is concerned about heart attacks and strokes whilst taking diclofenac, please see your GP who, depending on any other existing medical conditions, may advise you not to take NSAIDs. GPs are unlikely to prescribe NSAIDS if you have had a heart attack or stroke or are at increased risk of heart disease due to high blood pressure, high cholesterol or diabetes."

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