Aimee Lettis from the GP Update team gives us short, sharp nuggets of clinical information for sessional GPs.
They’re one of the commonest painkillers used in primary care. But if, like me, you’re always slightly anxious about prescribing an NSAID, you may find this review on NSAIDS useful. First though, here’s a warning about diclofenac for those still prescribing it.
Drug Safety Update on diclofenac
Following a recent Europe-wide review of the cardiovascular safety of diclofenac, the MHRA has made new recommendations about prescribing oral (not topical) diclofenac (Drug Safety Update 2013;6(11):2).
- The cardiovascular risk of diclofenac is as bad as COX-2 inhibitors.
- For every 1000 patients taking diclofenac compared to placebo for 1 year, an extra 3 will have a major vascular event, giving a NNH of 333/year.
- Diclofenac now contraindicated in:
- Ischaemic heart disease
- Peripheral vascular disease
- Cerebrovascular disease
- Congestive cardiac failure