Diclofenac commonly used worldwide, despite CV risks

Diclofenac, a nonsteroidal anti-inflammatory drug, has been linked to MI and stroke risk in vulnerable patients, but new data show that it is widely prescribed worldwide, according to new research in PLoS Medicine.

Patricia McGettigan, MD, from the William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, United Kingdom and David Henry, MBChB, MRCP, FRCP, from the Institute for Clinical Evaluative Sciences and the University of Toronto, Canada, studied Essential Medicines Lists obtained from the WHO that listed NSAID sales and prescription data for 15 low-, middle- and high-incomes countries.

Three drugs — diclofenac, rofecoxib and etoricoxib — consistently ranked as having the highest CV risks, compared with nonuse. Diclofenac and etoricoxib accounted for one-third of total NSAID use across the 15 countries (median, 33.2%).

Despite known risks, diclofenac was included on the Essential Medicines Lists of 74 countries. Naproxen, a safer alternative, was on just 27 lists.

The CV risks associated with diclofenac are almost identical to those of rofecoxib (Vioxx, Merck), which was discontinued in 2004.

The researchers reported no difference in use between low- and high-income countries.

"Given the availability of safer alternatives, diclofenac should be de-listed from national Essential Medicine Lists," McGettigan stated in a press release. "There are strong arguments to revoke its marketing authorizations globally."

For more information:

McGettigan P. PLoS Med. 2013;doi:10.1371/journal.pmed.1001388.

Disclosure: McGettigan and Henry report no relevant financial disclosures.