Diclofenac: Pain Relief or Heart Disease Risk?

I use a lot of analogies in explaining medical issues to my patients.  Case in point is the double edged sword which cuts both ways.  In other words, it can be used for both good & bad.  A good example of this double edged sword is the non-steroidal anti-inflammatory drug (NSAID) class of pain relievers.  They do a great job of relieving pain & reducing both inflammation & fever.  However, they do so no without risk such as gastritis, peptic ulcer disease, and even gastrointestinal hemorrhage.  They can also injure the kidneys and increase blood pressure so clearly, their use needs to be monitored closely.

Another analogy that I like to use is that of the car industry.  Try as Detroit might, I can't believe that one manufacturer, eg Ford, Chevy or Dodge, stands head & shoulders above the other two.  Same goes for Honda, Nissan & Toyota in Japan.  They all make good products.  It just comes down to individual preferences.  Well, the same goes for all the different drugs in the NSAID class.  In general, they each reduce pain, fever & inflammation.  But of course, some individuals may perceive more benefit from one than another.

However, within this NSAID class, there are differences as to risk for heart disease.  As noted in a nice review published in PLoS Medicine, the authors noted that rofecoxib, diclofenac & etoricoxib rank highest risk for heart disease compared to non-use while naproxen is ranked as low risk.  Despite this widespread knowledge, diclofenac & etoricoxib accounted for one of every three NSAID pills sold in 15 countries worldwide regardless of income level.  In fact, higher risk diclofenac was considered an essential medication by 74 countries while lower risk naproxen was considered essential in only 27 countries.

In other words, government officials in charge of policy are ignoring evidence-based medicine.  Luckily for you & me, we have a choice here in the States.  We have ready access to lower risk naproxen (while higher risk diclofenac is still available to those few individuals who don't respond to any other NSAID).

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