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Heart risk from the painkiller diclofenac

Posted by Eamonn Brady on

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to


The European medicines watchdog issued a warning in July 2013 stating that diclofenac can significantly increase the risk of heart problems such as heart attack and stroke in those already at risk of these problems. Diclofenac is a Non-Steroidal Anti-inflammatory Drug (NSAID) used as an anti-inflammatory painkiller. Many Irish people take diclofenac for a range of conditions such as back pain, arthritis, gout and headaches. Brands of diclofenac available on prescription in Ireland include Diclac® tablets, Difene® Capsules, Voltarol® tablets and Catoflam® tablets.


The Health Product Regulatory Authority (Irish Medicines Safety Advisory Body) is advising doctors not to prescribe diclofenac for patients with a history of heart and circulation problems including heart failure, ischaemic heart disease (eg. Angina, previous heart attack), stoke and arterial thrombosis (eg. blood clots). People who are smokers, are diabetic, have high blood pressure or have high cholesterol should also use diclofenac in caution (even if they do not currently have heart problems) as these conditions increase your risk of heart disease and diclofenac further increases this risk.


The warning covers diclofenac administered rectally (eg Difene® suppositories) as well as oral versions mentioned above. The warning does not include topical versions of diclofenac such as creams and gels. Thus topical versions such as Difene® Gel, Voltarol® Gel or Difene® Gel are still considered safe for cardiac patients. Diclofenac is still considered to be safe for those without heart problems.


There was a similar warning a few years ago for another class of prescription only anti-inflammatory painkillers called COX-2 NSAIDs. COX-2 NSAIDs include brands like Celebrex® and Arcoxia®; these too must be avoided in people with heart problems.


Anti inflammatory painkillers that do not have a major cardiac warning (as of yet) include ibuprofen, meloxicam, naproxen and meloxicam. Hence doctors may consider prescribing these in cardiac patients where analgesia is required. Ibuprofen is available over the counter without prescriptions (eg. Nurofen®) but I would not advise people with heart problems using Ibuprofen without first consulting with their pharmacist or doctor; this is because it can cause problems like raised blood pressure which can put pressure on the heart. Anti-inflammatory medicines must be used with care for other reasons too and should not be used long term (unless under supervision of your doctor). Apart from potential heart problems, they can cause stomach ulcers, trigger asthma attacks in asthmatics and should be avoided by those with kidney problems.


New Chartered Physiotherapy Service in Mullingar

In line with our vision to offer as wide a range of quality health services to the local community as possible, Whelehans Pharmacy are delighted to announce their new Physiotherapy service, Health Step Physiotherapy, operated by fully qualified Chartered Physiotherapist, Kevin Conneely MISCP. Kevin offers reduced physiotherapy rates for under-18s, students with valid student ID and for Over 65’s. He also offers reduced rates for affiliated sports clubs and other groups. Health Step Physiotherapy is now available to book. Simply contact Kevin on 087 4626 093 to advice or call Whelehans at 04493 34591 to book an appointment. Check for more info.

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