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S ep tem
b er 2
Diclofenac and cardiovascular risk
• Paracetamol is preferred first line to NSAIDs because it is an effective analgesic and has a
much low er risk
of adverse effects. C onsider adding an NSAID w hen paracetamol ( and non
) does not provide adeq uate pain relief.
hen considering starting or sw
itching NSAIDs, consider the individual patient’ s risk
adverse effects, including cardiovascular, gastrointestinal and renal complications.
• People at high risk
of the above adverse effects should avoid using an NSAID if possible.
If an NSAID is used, it should be at the low est effective dose for the shortest possible
duration to minimise the risk
of adverse effects.
edia reports of a study show
ing an increased risk
of serious vascular events ( such as my ocardial
infarction) associated w
ith diclofenac have raised concerns that patients tak ing diclofenac should
itched to another NSAID. 1
o es thi s r ev
l e tak
f en ac?
At present it is difficult to say w
ith any certainty that one NSAID is associated w
ith higher risk
than another. It w ould be premature to recommend that all patients immediately stop tak ing
diclofenac on the basis of this review
alone. T he review
does not provide definitive evidence of
elevated vascular risk
ith diclofenac. In addition, evidence of vascular risk
diclofenac should be considered alongside other k now n risk s of NSAIDs.
T he decision to use an NSAID and the choice of drug should tak e into account the individual
patient’ s risk