The IMB are advising doctors not to prescribe diclofenac for patients with a history of heart and circulation problems including heart failure, ischaemic heart disease (eg. Angina, previous heart attack), stoke and arterial thrombosis (eg. blood clots). People who are smokers, are diabetic, have high blood pressure or have high cholesterol should also use diclofenac in caution (even if they do not currently have heart problems) as these conditions increase your risk of heart disease and diclofenac further increases this risk. Research published in 2011 found that patients taking diclofenac were found to have a 40% increased risk of heart problems such as heart attack or stroke compared to those who were not using the drug. However, for most people; diclofenac only causes a slight increase in risk of heart problems
The warning covers diclofenac administered rectally (eg Difene® suppositories) as well as oral versions mentioned above. The warning does not include topical versions of diclofenac such as creams and gels. Thus topical versions such as Difene® Gel, Voltarol® Gel or Difene® Gel are still considered safe for cardiac patients. However, topical versions should be used in caution with patients prescribed warfarin as even rubbing it onto a small area of skin can increase the effect of warfarin which could lead to bleeds. Diclofenac is still considered to be safe for those without heart problems.
Anti inflammatory painkillers that do not have a major cardiac warning (as of yet) include ibuprofen, meloxicam, naproxen and meloxicam. Hence doctors may consider prescribing these in cardiac patients where analgesia is required. Ibuprofen is available over the counter without prescriptions (eg. Nurofen®) but I would not advise people with heart problems using Ibuprofen without first consulting with their pharmacist or doctor; this is because it can cause problems like raised blood pressure which can put pressure on the heart. Anti-inflammatory medicines must be used with care for other reasons too and should not be used long term (unless under supervision of your doctor). Apart from potential heart problems, they can cause stomach ulcers, trigger asthma attacks in asthmatics and should be avoided by those with kidney problems.By Eamonn Brady MPSI
*HSE Primary Care Reimbursement Service. Statistical Analysis of claims and payments 2010.
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