Doctors love NSAIDs (nonsteroidal anti-inflammatory drugs). That’s largely because they don’t have a lot of other tools in the toolkit when it comes to treating pain and inflammation. Opioids have been demonized and doctors have been chastised if they prescribe hydrocodone or oxycodone for chronic pain. As a result, 60 million prescriptions are dispensed annually for drugs like meloxicam, naproxen, diclofenac, celecoxib, nabumetone and indomethacin. Now a new study reports that diclofenac (Cataflam, Voltaren) is associated with serious cardiovascular complications (BMJ, September 4, 2018). What should you know about the dangers of diclofenac?
What Are the Dangers of Diclofenac?
Diclofenac is available without a prescription in most European countries. In the U.S. it is only available by prescription, though similar drugs (ibuprofen and naproxen) are sold over the counter.
Danish scientists wondered whether diclofenac carried risks similar to those of rofecoxib (Vioxx), which was pulled off the market because it was linked to excess heart attacks and strokes. They analyzed data from the Danish National Health Service which keeps records on all Danish citizens.
The study included 1.4 million people who started taking diclofenac. They were compared to 3.9 million people starting on ibuprofen, 291,000 people on naproxen, 765,000 people starting on acetaminophen (paracetamol) and 1.3 million people taking no pain relievers. Such numbers are impressive.
The researchers found that people taking diclofenac were 50% more likely to experience a serious adverse event than those who were not taking any pain relievers. The complications included the heart rhythm disturbances (atrial fibrillation or flutter), clotting strokes, heart failure, heart attacks and cardiac death. They were also more likely to experience such side effects than people taking the other pain relievers.
The dangers of diclofenac began to show up within the first 30 days of treatment. Even low doses posed a risk. This contradicts the perception that short-term treatment is safe.
The Dangers of Diclofenac for the Digestive Tract:
It’s not just the heart and cardiovascular system that’s at risk from NSAIDs. Gastroenterologists have long recognized that drugs like diclofenac, ibuprofen, meloxicam and naproxen can cause serious ulceration and hemorrhage of the stomach and small intestine. The Danish investigators noted that diclofenac and naproxen were both associated with upper gastrointestinal bleeding at a rate 4.5 times higher than that of people not taking pain relievers.
The authors concluded:
“It is time to acknowledge the potential health risk of diclofenac and to reduce its use…Our data support that initiation of diclofenac poses a cardiovascular health risk, both compared with no use, paracetamol use, and use of other traditional NSAIDs.”
Other Dangers of Diclofenac:
- indigestion and heartburn
- nausea and vomiting
- itching or hives
- sensitivity to sunlight
- elevated liver enzymes
- swollen legs or feet
- tinnitus (ringing in the ears)
- delayed ovulation
- digestive tract bleeding
- perforated ulcer
- atrial fibrillation or flutter
- heart attack
- blood clots
- high blood pressure
- congestive heart failure
- kidney injury
- liver damage
- elevated potassium levels
- Stevens-Johnson syndrome
People’s Pharmacy Perspective:
The Danish investigators recommend that diclofenac should not be available over the counter. Of course, in the US it is not, but both ibuprofen and naproxen are. The Danish study showed that the risks of gastrointestinal bleeding from naproxen are equivalent to those from diclofenac. And although the cardiovascular risks of diclofenac appeared slightly higher in this study than those of ibuprofen or naproxen, all NSAIDs can cause similar harms. We hope that people will use such medications only when absolutely necessary and treat them with the respect that is due potentially deadly drugs.