Stop taking diclofenac without prescription, drug safety board warns

A painkiller that increases the risk of heart attack and stroke may be overprescribed in Kenya’s pharmacies and chemists, drug safety Board has warned.

A statement by the Pharmacy and Poisons Board released on Friday warned that taking diclofenac regularly and for a long period of time for management of pain causes stroke and heart attack.

The statement signed by the Chief Executive Officer, Dr Fred Siyoi warned that the drug should not be taken by patients with heart failure, and blockage of blood vessels to the heart and brain.

Dr Siyoi said that on many occasions, diclofenac was a common choice over other painkillers for many Kenyans despite its higher risk of side effects.

 Out of ten patients in Kenya in pain, four are buying the drug without a prescription from doctors and this is worrying.

 “At the end of the day, no chemist will chase a patient who is bringing money. It is now a upon the patient to ensure that before you purchase this particular drug, it is prescribed by the doctor,” Dr Siyoi said

He challenged the drug sellers to sell the drug only to patients with prescriptions.

“Let’s take care of our health as a country and be your brother’s keeper, we are only doing this to prevent a possible attack that you could be causing to yourself unknowingly,” he said

The statement warned that Kenyans with high blood pressure, those smoking cigarettes, diabetes and those with high blood cholesterol need permission on whether they should take the drug and how best to take it.

“Diclofenac is not usually recommended for people who have existing heart disease,” he said

 Diclofenac is often used to treat painful conditions like arthritis.

They are normally prescribed at the lowest possible dose for the shortest time to cut the chance of side effects.

“If it is a must that one should use the drug, it should be used for the shortest time necessary and at the lowest dose possible to control symptoms and possible long term effects of the drug,” he said.

A paper in the journal PLOS Medicine found out that despite the warnings the drug's cardiovascular risk hasn't translated to a reduction in use.

"If you look at it internationally, diclofenac is the single most widely used drug for pain management, says study author David Henry of the Institute for Clinical Evaluative Sciences in Toronto.

 From the findings of the study, diclofenac raises the risk of a cardiovascular "event" such as heart attack by about 40 percent, compared to taking no drug.

"Clearly thousands of people die as a result of using [diclofenac]," Henry says. "But these are invisible victims adding that there's a perception that diclofenac is a more potent painkiller than others.

“We think that's just because it's been marketed in high doses." Higher doses also magnify the cardiovascular risk.

“We will continue reviewing any safety concerns that arise with the use of medicines after-market authorization in order to put in place risk minimization measures and promote rational use while ensuring patient safety,” Dr Siyoi said.

He said despite the fact that the benefits of using the medicines outweigh the risks, it is important that Kenyans follow the outlined guidance for use and avoid self–medication.

“For those who are safe to use it, can go ahead and use it, however, it has to be prescribed by a medic after thorough verification that the patient is safe,” Dr Siyoi said.