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Researchers Urge Diclofenac Ban

by Cooper B. Wilhelm

The results of a recent study have prompted researchers at the Institute for Clinical Evaluative Sciences in Toronto and the William Harvey Research Institute in London to demand a global ban on diclofenac, a common pain medicine, which they say is linked to an increased risk of heart attacks and other cardiovascular problems.

The study, published online by the open-access journal PLOS Medicine, compiled data from multiple studies that had themselves compiled data from multiple studies to compare the risks associated with using certain nonsteroidal anti-inflammatory drugs (NSAIDs). The researchers juxtaposed this information with how widely each of the drugs was used and how often each appeared on national lists of “essential” medicines. They found that although diclofenac is a consistently popular first-line pain remedy, it was one of the most dangerous for a person’s heart.

The researchers say taking diclofenac (as opposed to no NSAIDs at all) may raise a person’s risk of serious heart problems as much as taking the once-popular painkiller rofecoxib (brand name Vioxx). Vioxx’s manufacturer, Merck, pulled Vioxx off the market in 2004, after an FDA report stated that certain doses of the drug almost doubled the risk of a heart attack or sudden cardiac death and estimated that in the four years Vioxx had been available, nearly 28,000 such events could have been avoided had people taking Vioxx taken a different drug instead. Similarly, the authors of this study estimate that suspending the use of diclofenac in China, for example, could save as many as 14,000 lives a year.

In the United States, diclofenac is available in several forms with different brand names. All of them require a prescription for purchase. The study authors believe that only the oral forms of diclofenac, such as Arthrotec and Cataflam, come with this steeply increased risk of heart issues. The diclofenac patch Flector and diclofenac that is rubbed into the skin, Voltaren Gel, would not introduce enough diclofenac into the bloodstream to have the same heart risk.

Topical diclofenac could therefore serve as a safer form of the drug for people with arthritis. However, the study authors point to naproxen (Aleve) as a lower-risk alternative that they suggest is greatly underused. “Based on the meta-analyses of randomized and non-randomized studies, the greatest amount of evidence supports naproxen as the safest choice to minimize cardiovascular risk,” the researchers said.

The study had limitations, however. Most notably, the researchers had little information about the other risk factors affecting the people in the studies. They were also unable to factor dose sizes into their calculations. It may also be worth noting that the United States was not among the 15 countries studied.

Last Reviewed on February 21, 2013

Cooper B. Wilhelm is an Editorial Assistant at Arthritis Self-Management.

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