According to a recent study, the painkiller diclofenac could be associated with an increased risk of major cardiovascular events, such as heart attack and stroke. The study also discovered those who took the painkiller had a 50 percent higher risk of heart problems or a stroke than someone who did not take the medication.
It is widely used to treat a range of conditions including headaches, back pain, arthritis and flu. The drug requires a prescription in the United States, though in other countries it is available over the counter. Researchers also said that the drug should come with an appropriate front package warning to inform users of its potential health risks.
But they can still be bought over the counter in most countries, including the US.
"While NSAID use previously was considered risk-neutral in short treatment periods and low doses, the risks were apparent even within 30 days and also for low doses of diclofenac".
The report, which was conducted by researcher Morten Schmidt at Aarhus University Hospital in Denmark, concludes that patients should try out other NSAIDs before taking pills containing diclofenac as a last resort.
The results are based on national registry data for more than 6.3 million adults in Denmark with at least one year of continuous prescription records before study entry in January 1996.
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Diclofenac, marketed as Voltarol in the United Kingdom, has been linked with heart failure and irregular heartbeats, and has recently been withdrawn from sales over the counter in the United Kingdom due to concerns about side effects.
The authors point out that, although the relative risk was increased, the absolute risk remained low for the individual patient.
The study also relies on observational data, so it can't directly prove that diclofenac is causing problems. Diclofenac is a traditional NSAID that has similar selectivity for cyclo-oxygenase-2 (COX 2) as COX 2 inhibitors, but the cardiovascular risks of diclofenac in comparison with other traditional NSAIDs have not been investigated through a randomized controlled trial.
"Treatment of pain and inflammation with NSAIDs may be worthwhile for some patients to improve quality of life despite potential side effects", the team wrote in a statement regarding the study.
For those with the lowest baseline risk, starting diclofenac was associated with one extra event per 1000 patients per year, compared with those starting ibuprofen or naproxen; three extra events compared with those starting paracetamol; and four extra events compared with those taking no NSAIDs. Considering its cardiovascular and gastrointestinal risks, however, there is little justification to initiate diclofenac treatment before other traditional NSAIDs.