The Medicines and Healthcare Products Regulatory Agency have directed that diclofenac is now contraindicated in patients with congestive heart failure (New York Heart Association classification II–IV), ischaemic heart disease, peripheral vascular disease (PVD) and cerebrovascular disease, due to the increased risk of arterial thrombosis.1 Patients on diclofenac should see their GP at their next routine appointment to be switched to an alternative treatment.1
We carried out an audit in an urban general practice of 13 000 predominantly white patients in Yorkshire to establish the number of patients affected by these recommendations and the subsequent impact on GP workload.
We identified 933 patients with one or more of the diagnoses recognised as contraindicating the use of diclofenac. Four hundred and eighty patients had ischaemic heart disease alone of whom 21 had been prescribed diclofenac in the last 12 months, with 10 on repeat prescription. Thirty-three patients had congestive heart failure alone of whom only one had been prescribed diclofenac (not on repeat prescription). Sixty-one patients were diagnosed with PVD alone; four had been prescribed diclofenac of whom one required a repeat prescription. One hundred and ninety-three patients had a diagnosis of cerebrovascular disease alone; 11 had been given a prescription of diclofenac, six on repeat prescription. One hundred and sixty-six patients had more than one of these conditions, and four had been prescribed diclofenac on repeat prescription.
In total 41 patients with any of the relevant diagnoses had been given diclofenac in the preceding 12 months, of whom 19 had diclofenac on repeat prescription. Our results are somewhat reassuring as only 0.3% of our patient population have been exposed to diclofenac in the last 12 months with only 0.1% having diclofenac on repeat prescription. Although the service burden of these new recommendations is slight, the impact that the discontinuation of diclofenac will have on patients requiring them (particularly those that use diclofenac routinely) cannot be discounted.
- © British Journal of General Practice 2013
