Experts worldwide have been calling for diclofenac, a popular anti-inflammatory drug, to be pulled from the world market due to it’s cardiovascular side effects. This appeal was rejected by the United Kingdom as an over-reaction by many clinicians.
Diclofenac is an NSAID (non-steroidal anti-inflammatory drug). As a group, NSAIDs are used to combat pain and swelling in a variety of conditions, especially rheumatoid arthritis and osteoarthritis. Among the well-documented side effects of NSAIDs is the risk of developing serious cardiovascular problems leading to heart attack or stroke.
Diclofenac has a higher than average risk. Among healthy individuals, it’s relatively rare to develop heart disease (about 1 chance in 1000), but among patients prone to heart disease it dramatically increases. A patient with a 10% chance of heart attack or stroke sees an increase to a 14% chance for the same events. For many clinicians, this is an unacceptable risk, especially when other drugs can have the same effects with less risk.
Naproxen is widely regarded as a safer alternative to diclofenac. Ibuprofen is also a recommended replacement. Some doctors in the UK have found it a simple process to switch to one of these drugs, and patients get the same relief from their symptoms.
Many critics of diclofenac reference the fact that it’s risk of heart disease is about the same as rofecoxib (brand name Vioxx), which was pulled from the world market for its effects on the heart.
Proponents of the drug acknowledge that dicolfenac may not be the best choice for all patients, but it doesn’t necessitate a global ban. NSAIDs as a group aren’t recommended for any patients with existing heart conditions, so diclofenac shouldn’t be singled out as much more dangerous.
It would also be exceptionally difficult to limit the sale of diclofenac worldwide. While it’s not as common in Canada or the US, worldwide is the most widely prescribed anti-inflammatory drug. It’s included on essential medicines list in 74 countries, and it’s widely available over-the-counter.
Most importantly, many doctors find that diclofenac is a very useful drug, and that its benefits outweigh its risks. There are a variety of NSAIDs, and different drugs will be more or less effective at treating certain patients. Many doctors don’t want their treatment options limited, especially since patients are usually informed of the risks involved in taking NSAIDs.
As of early 2013, there is a Europe-wide review looking into the safety of diclofenac compared to other NSAIDs. Many experts are recommending switching patients to a drug with fewer side effects, such as naproxen. Though a ban has been rejected in the UK, debate continues on the safest way to treat debilitating pain and whether diclofenac is a good option.
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