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Painkiller Diclofenac for Arthritis Associated with Heart Problems

The medication has had an incidence rate of 20 to 30% compared to other NSAIDs.

A PPM Brief

Diclofenac, a popular NSAID used to treat arthritis and joint pain, has been linked to an increased risk of heart problems, including heart attacks, atrial fibrillation, or death, according to a new study out of Denmark.1 Researchers found that the rate of first-time cardiovascular events was 20 to 30% higher among those taking diclofenac compared to those taking other NSAIDs for arthritis/joint pain, such as ibuprofen or naproxen, as well as paracetamol (acetaminophen). Compared to patients not taking any painkillers, the rate of new heart problems was 50% higher among diclofenac users.

Diclofenac is indicated for such conditions as chronic polyarthritis, ankylosing spondylitis, osteoarthritis, gout, extra-articular rheumatism, post-traumatic and postoperative pain, and dysmenorrhea. It can be administrated as an intramuscular injection, ointment, gel, and eye drops. Of note, the study looked at diclofenac in tablet form.

(Source: 123RF)

Through a series of 252 nationwide cohort studies, researchers analyzed Danish population-based health registries from 1996 to 2016. Exclusion criteria included adults with malignancy and low baseline risk; schizophrenia; dementia; or cardiovascular, kidney, liver, or ulcer diseases. The study included 1,370,832 diclofenac initiators, 3,878,454 ibuprofen initiators, 291,490 naproxen initiators, 764,781 paracetamol initiators, and 1,303,209 non-initiators.

The adverse event rate among diclofenac initiators increased by 50% compared with non-initiators (incidence rate ratio 1.5, 95% confidence interval 1.4 to 1.7), 20% compared with paracetamol or ibuprofen initiators (both 1.2, 1.1 to 1.3), and 30% compared with naproxen initiators (1.3, 1.1 to 1.5). The event rate for diclofenac initiators increased for each component of the combined endpoint (1.2 (1.1 to 1.4) for atrial fibrillation/flutter, 1.6 (1.3 to 2.0) for ischaemic stroke, 1.7 (1.4 to 2.0) for heart failure, 1.9 (1.6 to 2.2) for myocardial infarction, and 1.7 (1.4 to 2.1) for cardiac death) as well as for low doses of diclofenac, compared with non-initiators. Diclofenac initiation also increased the risk of upper gastrointestinal bleeding at 30 days, by approximately 4.5-fold compared with no initiation, 2.5-fold compared with initiation of ibuprofen or paracetamol, and to a similar extent as naproxen initiation.1

The researchers concluded that diclofenac “poses a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional non-steroidal anti-inflammatory drugs.”

Last updated on: October 26, 2018
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