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Despite warning: many high-risk patients still receive diclofenac
Six years ago, a so-called red hand letter warned the medical profession in Germany that the pain reliever diclofenac should no longer be prescribed for certain patient groups. However, many high-risk patients still receive this drug.
Although it has been known for years that taking diclofenac in heart patients can significantly increase the risk of heart attacks and strokes, numerous high-risk patients continue to receive the pain reliever. This is the conclusion reached by scientists from the Leibniz Institute for Prevention Research and Epidemiology - BIPS in a study published in the journal "Journal of Internal Medicine" (JIM).
German medical profession was warned six years ago
As the Leibniz Institute for Prevention Research and Epidemiology - BIPS wrote in a message, a so-called red hand letter warned the German medical profession in 2013 that diclofenac should no longer be prescribed for certain patient groups.
“Diclofenac is now contraindicated in patients with existing heart failure (New York Heart Association, NYHA, stages II-IV), ischemic heart disease, peripheral artery disease or cerebrovascular disease. Treatment should be checked for patients with these diseases, ”says the Red Hand Letter published by the Federal Institute for Drugs and Medical Devices (BfArM).
A similar risk profile as diclofenac showed a drug called Vioxx (active ingredient rofecoxib), which has led to numerous cardiovascular deaths and was therefore withdrawn from the market in 2004, explains the BIPS.
New contraindications are not reflected in prescribing behavior
On the basis of health insurance data, the researchers at BIPS investigated the prescription behavior regarding diclofenac before and after the Red Hand Letter from 2013.
It turned out that in 2014 compared to 2011 in absolute terms significantly less diclofenac was prescribed for the first time. In 2014, 30 percent less of the over ten million people examined received diclofenac for the first time than in 2011.
However, in 2014, twelve percent of people with the diclofenac prescription had a cardiovascular contraindication - just as high as in 2011.
“So the decline in diclofenac prescriptions appears to have been a general trend and has had no particular impact on high-risk groups. The new contraindications are not really reflected in the prescription behavior, ”explains student author Oliver Scholle from BIPS.
Further analyzes planned
“We are planning further analyzes with even more up-to-date data, but we do not expect anything to change the prescription behavior without further measures. One must assume that these ordinances resulted in heart attacks and strokes that could have been avoided, because there are safer alternatives to diclofenac, "said Prof. Dr. Ulrike Haug, last author of the study and head of the clinical epidemiology department at BIPS.
The scientist adds: "More information in medical practices about the risks of diclofenac - even with short-term use and a lower dose - is urgently needed, as well as studies that examine how prescription behavior in risk groups can be permanently influenced." (Ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.