New Vision (Kampala)

Uganda: Painkiller 'Diclofenac' Linked to Heart Attack

Diclofenac, a pain killer that increases the risk of heart attack and stroke, is easily accessible across Uganda. Virtually, every drug shop and pharmacy is selling it without prescription.

The Ministry of Health agreed that the drug can cause problems if not well managed. The permanent secretary in the ministry, Dr. Asuman Lukwago said Diclofenac in Uganda is not supposed to be sold over the counter, but should be prescribed by a qualified doctor, who knows how much to give and when.

He said indiscriminate access is dangerous and blamed the practice on the poor enforcement of the laws concerning drugs.

"We use Diclofenac in normal ranges just like any prescription drug should be," Lukwago said.

"That is why we do not prescribe it in some cases like in early pregnancy because it can affect the foetus. There are other problems that can come due to wrong use including problems with the bone marrow," he added.

Research findings:

The study said Diclofenac was a common choice over other pain killers in a number of countries, including in the UK, despite its higher risk of side effects.

The study further That it and others in its category are widely used in low-middle as well as high-income countries of which Uganda is one.

The report pointed out that while prescribing of Diclofenac could be entirely appropriate; there are concerns that it might be the wrong choice for some patients.

The background to the study was that non-steroidal anti-inflammatory drugs (NSAIDs) including diclofenac increased the risk of heart attacks and stroke and should be avoided by patients at high risk of these conditions.

Scope of research:

The researchers studied the extent to which evidence on heart disease risk with NSAIDS has translated into guidance and sales in 15 countries.

It concluded that diclofenac has a risk very similar to rofecoxib, which was withdrawn from the worldwide market due to cardiovascular toxicity and should be removed from the essential medicines lists (EMLs).

Diclofenac is the most popular NSAID, despite its higher relative risk of cardiovascular events, which is similar to that of rofecoxib. It is also widely listed on EMLs even though information on its higher cardiovascular risk has been available since 2006, the study established.

Essential drugs:

Essential medicines are those satisfying the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness under the guidance of the WHO model List of Essential Medicines.

The WHO Model List of Essential Medicines includes three drugs, paracetamol, acetyl salicylic acid (aspirin), and ibuprofen, in the category "non-opioids and non-steroidal anti-inflammatory medicines." Of 100 countries

The report said that although heart and circulatory complications are relatively rare - estimates suggest three patients in every 1,000 treated on Diclofenac for a year will develop such complications as a result of their medication - doctors are careful about prescribing the drug.

Diclofenac is not usually recommended for people who have existing heart disease.

Europe reviews Diclofenac:

The study also indicated that there is an ongoing Europe-wide review of diclofenac safety. Experts however, say that the absolute risk of complications with diclofenac is small and patients prescribed this drug by their doctors should stay on it.

They also warned that these NSAIDS should be understood on an individual basis rather than "tarnish them all with the same brush".

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