Side-effects of the use of NSAIDs, such as an increased risk of serious morbidity like gastric haemorrhage and cardiovascular diseases, have been known for years. Recent Danish research shows that the risk of a first cardiovascular disease associated with short-term use is greater for diclofenac than for other NSAIDs, even within 30 days of use! This means that there is concern about just a few weeks of self-treatment of back pain with diclofenac bought at the chemist’s. This was already known to be the case for people with existing cardiovascular diseases, but it is now known to be true for people without cardiovascular disease as well. So why not stop selling NSAIDs like diclofenac over the counter, and making these drugs only available on prescription for short-term use?
- A large-scale Danish cohort study has found that the risk of a first cardiovascular disease is statistically significantly greater for 30 days of using diclofenac than for 30 days of using other NSAIDs or paracetamol.
- The study provides an argument for even greater vigilance in prescribing and dispensing NSAIDs, especially diclofenac.
- The Danish findings suggest that if patients without cardiovascular disorders or stomach complaints need short-term NSAID treatment, naproxen or ibuprofen should be preferred over diclofenac.
- The strong association between diclofenac and first-time cardiovascular disease arising within 30 days would be a major argument to stop selling this drug over the counter.
- Schmidt M, Sørensen HT, Pedersen L. Diclofenac use and cardiovascular risks: series of nationwide cohort studies. BMJ 2018;362:k3426.
- EMEA statement following withdrawal of Vioxx (rofecoxib) Doc. Ref. EMEA/97949/2004. Via: www.ema.europa.eu/documents/press-release/emea-statement-following-withdrawal-vioxx_en.pdf.
- Informatorium Medicamentorum. Den Haag: KNMP, 2018. Via: KNMP Kennisbank.
- Goodman&Gilman’s The pharmacological basis of therapeutics 13th edition. Brunton LL, Hilal-Dandan R, Knollmann BC. New York: Mc Graw Hill Medical, 2018.
- Commentaren Medicatiebewaking 2017/2018. Houten: Stichting Health Base, augustus 2017.
- Vollaard EJ, Kramers C, Brouwers JRBJ. Interactie NSAID's en acetylsalicylzuur genegeerd. Ned Tijdschr Geneesk 2014;158: A7893.
- Coxib and traditional NSAID Trialists' (CNT) Collaboration, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013;382(9894):769-79.
- De Jong L, Janssen PGH, Keizer D, Köke AJA, Schiere S, Van Bommel M, et al. NHG-Standaard Pijn 2018. Via: https://www.nhg.org/standaarden/volledig/nhg-standaard-pijn.
- Nieuwsbericht CBG. Diclofenac blijft de aandacht houden van het CBG. 7 september 2018. Via: https://www.cbg-meb.nl/actueel/nieuws/2018/09/07/diclofenac-blijft-de-aandacht-houden-van-het-cbg.
- GIPdatabank. College voor Zorgverzekeringen. Via: www.gipdatabank.nl.