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Diclofenac: a habit that needs changing

Diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), is routinely used, despite evidence of a greater risk of adverse cardiovascular events when compared with other NSAIDs such as ibuprofen or naproxen, whereas it offers no additional benefit.

Exposure to a nonsteroidal anti-inflammatory drug (NSAID) increases the risk of adverse cardiovascular events. For many years, diclofenac has been considered a good  choice of NSAID, and using it has become a habit.

The results of an extensive Danish study confirm the data already available: as compared with ibuprofen or naproxen, taking diclofenac exposes patients over the next 30 days to more cardiovascular events such as ischaemic stroke, heart failure or myocardial infarction, while offering no additional benefits or improved efficacy. Nor does it reduce the risk of other adverse events such as gastric bleeding.

This widely shared scientific observation, for example by the European Medicines Agency, has not led to a change in practices. For example, in 2018, the French health insurance system reimbursed approximately 5.5 million boxes of diclofenac for oral use.

The inertia of institutional decision-makers in the face of the fact that a habitually prescribed common drug is more harmful than beneficial undermines quality care.

Patients and healthcare professionals can combat this inertia without waiting for institutions, by challenging and breaking the habit of prescribing and taking diclofenac: there are alternatives that are equally effective but less risky.

There is no such thing as a "lifelong" treatment: therapeutic choices must be revised as new evidence emerges.

©Prescrire 1 December 2019

"Diclofenac: greater cardiovascular risk than with ibuprofen or naproxen" Prescrire Int 2019; 28 (209): 298-299. (Pdf, subscribers only).

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See also:

Drugs to avoid in 2019
(April 2019)
Free

NSAIDs and serious
cardiovascular disorders:
especially cox-2 inhibitors
and diclofenac
Prescrire Int  2016 ;
25 (167) : 14-16.
Pdf, subscribers only