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Researchers call for Voltaren, other diclofenac drugs to be pulled from world markets

The painkiller diclofenac, sold as Voltaren, should be pulled from the market, argue researchers from the UK and Canada…

Voltaren remains a popular painkiller in Australia, despite known health risks. Alison Young

The painkiller diclofenac, sold as Voltaren, should be pulled from the market, argue researchers from the UK and Canada, after finding it remains popular despite known cardiovascular risks.

Scientists have known for over a decade that some non-steroidal anti-inflammatory drugs such as diclofenac were associated with heart attacks and strokes in vulnerable patients.

In a study published today in the journal PLOS Medicine, researchers found that diclofenac, on average, was the most commonly used NSAID in 15 countries studied, despite being associated with more cardiovascular complications than other NSAIDs, including naproxen.

Diclofenac is the third most popular NSAID in Australia.

Researchers looked at the national essential medicine lists from 100 countries, and found 74 of them listed diclofenac, while only 27 listed naproxen.

The researchers said in their paper it was likely that diclofenac was taken by many individuals at high risk of cardiovascular events.

“We believe there’s no advantage over safer drugs, and we believe it should be withdrawn from world markets,” Dr David Henry of the Institute for Clinical Evaluative Sciences in Canada told CBS News.

“Given the availability of safer alternatives, diclofenac should be de-listed from national essential medicine lists,” said study lead author Dr Patricia McGettigan, from the William Harvey Research Institute in London.

Essential medicines lists form the basis of national drugs policy and government subsidies for drugs in many countries. Changing the status of diclofenac in Australia could see it removed from the Pharmaceutical Benefits Scheme.

In an accompanying Perspective on PLOS Medicine, K. Srinath Reddy from the Public Health Foundation of India and Ambuj Roy from the All India Institute of Medical Sciences, said the dangers of keeping potentially harmful drugs on EMLs in low- and middle-income countries were especially high.

Professor Reddy and Dr Roy, who were not involved in the study, said the results suggested immediate action to remove diclofenac from EMLs was warranted, and that the World Health Organization should provide information on the safety of NSAIDs.

Professor Paul Rolan from the University of Adelaide said the study confirmed what was already known about diclofenac.

“The real issue in pain is balancing benefit against potential for harm,” said Professor Rolan, who was not involved in the study.

He said that all painkillers had some side effects, and it was important for patients to make informed decisions.

“We’ve got paracetamol, we’ve got ibuprofen, we’ve got aspirin. They do all sorts of terrible things, but they also help pain.”

Professor Rolan said that for many patients, if a painkiller worked, it was worth taking.

He said his advice for diclofenac use was the same as for any other drug: “Use it when it works, use the lowest dose and use it for the shortest possible time.”

Voltaren cream that contains less than 1% of diclofenac was taken off Australia’s prescription medicine list and moved to pharmacy medicine in 1997.

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6 Comments sorted by

  1. Nicholas Roberts

    Software Engineer

    Do these issues apply to externally applied diclofenac cream?

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    1. Jan Burgess

      Retired

      In reply to Nicholas Roberts

      Nicholas

      I'm no doctor, but I do suffer from arthritis and the information I have been given is that the topical cream is not absorbed in significant amounts compared to the systemic treatment. Therefore it does not have anything like the same risks. My doctor told me it was essentially harmless (from the point of view of cardiovascular risks).

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    2. Keith Thomas

      Retired

      In reply to Jan Burgess

      Surely if it's not absorbed it won't be effective? Nicholas Roberts raises a good question, and I suspect that for some people - at least - topical diclofenac may not be risk free.

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  2. Ted Black

    Retired

    I know I am a minute sample size, but some years back when my right hip was in need of replacement my doctor tried first naprosan, which gave terrible burning in the chest feeling after about three doses, then voltaren which took about one more dose before the side effects were painful. I may be an outlier for side effects, but would prefer these NSAID's to be on prescription if they are to be used so that proper monitoring of side effects is undertaken.

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  3. john mills
    john mills is a Friend of The Conversation.

    artist

    “We’ve got paracetamol, we’ve got ibuprofen, we’ve got aspirin. They do all sorts of terrible things, but they also help pain.”

    He said his advice for diclofenac use was the same as for "any other drug" : “Use it when it works, use the lowest dose and use it for the shortest possible time.”

    Be good if psychiatry practiced the same philosophy, medicating regime.

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