Pain Drug May Spark Cardio Complications

Cardiovascular problems may be triggered by arthritis pain medication

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Diclofenac is frequently used for the treatment of pain and inflammation caused by arthritis. But the medication may also lead to heart problems.

A non-steroidal anti-inflammatory drug (NSAID) called Diclofenac (brand names Voltaren and Cataflam) is considered an “essential medicine” in 74 countries. 

A recent review showed that the medication may increase the risk of cardiovascular complications. Results also suggested that it should be removed from essential medicines lists.

"Avoid certain NSAIDs if you're at high risk of heart problems."

David Henry, MD, clinical pharmacologist with the Institute for Clinical Evaluative Sciences in Toronto, Ontario, conducted the review along with Patricia McGettigan, MD, at the London School of Medicine and Dentistry.

Diclofenac is the most widely used NSAID worldwide, although it only has about 5 or 6 percent of the NSAID market in the United States and 17 percent of the market in Canada.

Labeled an “essential medicine,” diclofenac is thought to “satisfy the needs of the majority of the population and therefore should be available at all times, in adequate amounts, in appropriate dosage forms and at a price the individual and community can afford,” according to World Health Organization.

In reviewing two observational studies, investigators noted that diclofenac elevated the risk of heart attack (acute myocardial infarction) by about 39 percent and increased the risk of cardiovascular events by 40 percent compared to non-use.

One randomized trial revealed that the likelihood of cardiovascular events was 63 percent greater in those who used the medication compared to those who did not.

Prescription doses range from 100 to 150 mg per day. Such doses are high enough to put the heart at risk. Higher doses are linked with even greater risks.

“When doctors prescribe NSAIDs, they need to consider the patient's risk profile. Particularly for patients with higher risk of cardiovascular events, a doctor should either advise against NSAID use or recommend one that has a relatively low cardiovascular risk,” wrote the authors.

Scientists noted that etoricoxib (brand name Arcoxia) and rofecoxib (brand name Vioxx) were also high risk NSAIDs. “The greatest amount of evidence supports naproxen [brand name Aleve, Naprosyn] as the safest choice to minimize cardiovascular risk,” wrote the researchers. They also singled out ibuprofen for its relative safety.

NSAIDs work by stopping enzymes called cyclo-oxygenases (COXs) from making molecules that cause pain and inflammation.

“Given the availability of safer alternatives, diclofenac should be de-listed from national essential medicine lists,” the authors concluded.

The review was published in February in PLOS Medicine: A Peer-Reviewed Open-Access Journal. No conflicts of interest were noted.

Reviewed by: 
Review Date: 
February 28, 2013
Last Updated:
March 3, 2013