Painkillers have side effects

Diclofenac: pain relievers with side effects

Status: 11/12/2018 1:59 p.m. | archive
Regular use of medication such as ibuprofen or diclofenac can increase the risk of heart attacks.

Drugs from the non-steroidal anti-inflammatory drug group (NSAIDs) such as diclofenac, ibuprofen or naproxen are among the most popular painkillers. They are available in low and medium doses without a prescription and are mainly used for pain and inflammation of the musculoskeletal system: Many are aware that these drugs cause stomach problems over the long term. But there are many more dangerous side effects, including heart attacks, strokes, and kidney failure.

Painkillers affect enzymes

The benefits and risks of the drugs are that they inhibit the enzyme cyclooxygenase (COX). There are two different subforms of the enzyme - cyclooxygenase-1 and -2. They have a central function in the regulation of inflammatory processes. They are also responsible for causing pain. They also influence blood clotting and are responsible for protecting the stomach lining and kidneys. If the enzyme is inhibited, several processes are affected at the same time.

Not every active ingredient increases the risk of cardiovascular disease in the same way. The side effects depend on which subgroup of cyclooxygenase is inhibited. The active ingredients ibuprofen and diclofenac inhibit both COX-1 and COX-2. Therefore, long-term, high-dose use of the medication can also increase the risk of gastric bleeding and kidney damage.

Warning from the European approval authority EMA

In the meantime, the European approval authority EMA warns patients with cardiac insufficiency, coronary artery disease, arterial occlusive disease or vascular diseases in the brain against the use of the active ingredient diclofenac and advises even smokers and people with high blood pressure, diabetes or high cholesterol levels to be more careful. The background is, among other things, the knowledge that NSAIDs worsen an existing heart failure and can impair the effectiveness of antihypertensive drugs.

Big differences in the effects of NSAIDs

There are differences between the individual NSAIDs that doctors should take into account when prescribing:

  • So is the active ingredient Naproxen particularly dangerous for the stomach, but this can be almost eliminated by combining it with substances that protect the stomach (proton pump inhibitors).
  • At Diclofenac In contrast, the risk of a heart attack and other vascular complications is significantly higher than with ibuprofen or naproxen. According to a Danish study with around six million data records, diclofenac carries a particularly high risk of cardiovascular problems, in the worst case it could lead to a fatal heart attack. In addition, there are interactions with other drugs such as ASA, whose platelet-inhibiting effect can be limited or even canceled by NSAIDs to protect against cardiovascular diseases.
  • Anyone who is dependent on both drugs should therefore take ASA as long as possible before the NSAID. Continuous use of NSAIDs can also cause headaches that should not be treated with NSAIDs because they will get worse.

Diclofenac as an ointment and tablet

Many pain medicine specialists and rheumatologists only use diclofenac for serious illnesses when there are no longer any alternative drugs available. Diclofenac can also cause problems when used as an ointment: If used regularly and over a large area, there are risks similar to those of diclofenac tablets. However, if you only occasionally apply diclofenac ointment to the affected joint for acute pain, you do not have to expect side effects.

Keep the duration of use and dosage as short as possible

Experts recommend keeping the duration and dosage of NSAID preparations as short as possible and using other drugs if the risk is increased. The problem: the analgesic effect of paracetamol is low, at the same time there is a risk of liver damage. The prescription Metamizol / Novaminsulfon can be a good alternative for severe symptoms, but in rare cases Metamizol can reduce the amount of white blood cells.

If possible, the symptoms should be combated primarily with non-drug methods such as physiotherapy, heat, cold, massages or exercise training. Under no circumstances should patients take NSAIDs for weeks without investigating the cause of their pain and consulting a doctor.

Experts on the subject

Dr. Jan-Henrich Stork, chief physician
Anesthesia, intensive care medicine and pain therapy
Hospital Tabea GmbH & Co. KG in the Artemed clinic network
Kösterbergstrasse 32, 22587 Hamburg
(040) 866 92-0

Dr. Peer M. Aries, rheumatologist
Rheumatology in the Struenseehaus
Mörkenstrasse 47, 22767 Hamburg-Altona
(040) 77 18 50 20-0

Dr. Matthias Janneck, senior physician
III. Medical clinic (nephrology, kidney transplantation, rheumatology, endocrinology / diabetology)
Center for Internal Medicine
University Medical Center Hamburg-Eppendorf
Martinistraße 52, 20246 Hamburg

Dr. Marko Remmel, senior physician
Clinic and Polyclinic for General and Interventional Cardiology
University Heart Center Hamburg GmbH (UHZ)
University Medical Center Hamburg-Eppendorf
Martinistraße 52, 20246 Hamburg

Dr. Maja Falckenberg
Alten Eichen pain clinic
Hohe Weide 17B, 20259 Hamburg
(040) 54 04 060

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Visit | 11/13/2018 | 8:15 pm