The UK has reclassified this common anti-inflammatory drug, so why haven’t we? 161



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Diclofenac is an anti-inflammatory drug used by millions of people all around the world. It is found in common medications like Cataflam and is sold over the counter here in Australia. Until this week, it has also been an over the counter drug in the UK but recent research has found it relatively high risk and has reclassified it, making it prescription only. So why isn’t Australia doing the same?

Research from Oxford University in 2013 found that for every 1,000 people with a moderate risk of heart disease taking 150mg of diclofenac for one year, about three would experience an avoidable heart attack and one of those three would be fatal.

This is a significant risk for someone who takes the medication every day. The Medicines and Healthcare products Regulatory Agency said that anti-inflammatory tablets containing the drug carry a “small but increased” risk of heart problems. All pills containing diclofenac will require a prescription however the gels for topical use will still be available over the counter.

If it has been deemed unsafe for over the counter administration in the UK, then why haven’t we done the same in Australia? In October 2014, the Australian Government Department of Health Therapeutic Goods Administration conducted a review of the risks associated with taking all non-steroidal anti-inflammatory drugs – this included ibuprofen, celecoxib, meloxicam and naproxen. They found that there were hepatotoxicity risks for diclofenac, which means damage to the liver.

Currently there is no immediate plans or action to change the administration of diclofenac, but the review did state that the labelling of both diclofenac and ibuprofen will be changed to state more clearly the associated risks and possible side effects of taking the drugs.

It brings up a large question of risk versus reward for the users of diclofenac. Does the relief from pain and positive quality of life outweigh the risk of serious cardiovascular health complications? Anyone who takes any medication, prescription or otherwise is faced with this question but when the risks are considerably higher it becomes a little more difficult.

If you’re concerned about taking anti-inflammatory medication, please consult your GP. 


Pharmacist, John Bell, Practitioner/Teacher, Graduate School of Health, University of Technology, wrote in to Starts at 60 with some information for readers who are concerned about the use of all NSAIDs… 


Starts at Sixty, 

I am writing in response to your recent article, ‘The UK has reclassified this common-anti-inflammatory drug, so why haven’t we?’ on the reclassification of the medicine diclofenac to prescription-only category in the UK.

As you have pointed out, diclofenac is one of a number of non-steroidal anti-inflammatory medicines (NSAIDs) which are widely prescribed, and some of which are available in pharmacies without prescription.

Long term use of all NSAIDs in prescription doses has been shown to increase the risk of heart attack or stroke, although the absolute risk is still very small. The risk is greatest for people with existing risk factors for cardiovascular (heart and blood vessel) disease. Long term treatment with any NSAID should only ever be under strict medical supervision.

Over-the-counter NSAIDs in Australia allow consumers access to effective medicines to manage short-term conditions painful conditions that may not require a medical appointment. For example, non-prescription oral diclofenac is available in pharmacies and intended for short term treatment only (a few days) of acute inflammatory pain, such as muscle strain and sprains. Scheduling of medicines in Australia takes into consideration how the medicines are intended to be used and the advice available on appropriate use at the point of supply.

It is important to recognise that all medicines which provide benefit also carry some risk. This applies to both prescription medicines and non-prescription medicines; and applies whether the non prescription medicines are purchased from a pharmacy, a supermarket or a health food store.

Before initiating treatment with any medicine the suitability of such treatment should be discussed with your GP or pharmacist. This especially applies if you have an existing medical condition and/or are taking other medicines.

John Bell AM BPharm FPS FRPharmS

Practitioner/Teacher, Graduate School of Health, University of Technology Sydney

Principal Advisor Self Care Program Pharmaceutical Society of Australia

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The Starts at 60 writers team seek out interesting topics and write them especially for you.

  1. Hmmm…interesting. .. yes I take Me logical every day..bby prescription for severely damaged knee joints. Been on it over 2 yrs. my Dr said 6 months at first but when I mentioned it she said…it’s om…don’t worry about it!! It was very effective for my increasing pain at that stage which was needing increasing amounts of ibuprofen for relief! Still waiting for surgery…!!!

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  2. I take celebrex and osteo panadol prescribed by the doctor but as far as pain goes I can tell you most of the time it just does not do much to alleviate it, but it does make it duller I suppose

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    • Look into Celebrex. It has more side effects than most, and found to be not very effective. Lot of controversy when it first came out.

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      • Thank you, Molly. I was prescribed Celebrex for my bad knee, with Panadol Osteo. I agree, neither drug seems to help very much. I made an appt last October with a specialist but it is not until late May. Seven months for a doctor’s appointment! That is country life for you, if you live in Australia. Meanwhile, I am doing physio.

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        • I was prescribed Panadol Osteo for my painful knee which I took for a couple of years. they have now caused liver damage so stopped taking them I take Meloxicam occasionally if the pain in my back caused by sever arthritis gets too bad as this has the same side effect as Panadol Osteo. Mostly I just have to put up with the pain. My LFT have slowly improved since stopping the Panadol Osteo. but still not quite normal. If anyone takes these drugs on a regular
          basis it is a good idea to have regular LFT as well, I have one every 6 months.

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          • Celebrex near ruined my life. I was on it for many years. I now have permanent problems caused by it. The problems was that I had bad side effects from it which resembled the same symptoms as arthritis.
            The more Celebrex I took the worse I became. I finally came off the Celebrex and have been so much better.

        • Angie, both my knees need replacing, I take 4 or 6 Panadol Osteo, plus 2 Voltaren and also 1,000mg capsules of Red Krill Oil a day, I really recommend the Red Krill Oil, it seems to have made the knees feel more stable.

    • I have the same sort of reactions to all non steroidal anti inflammatory drugs (NSAIDS) and many others. .stations included.

    • My dad had painful arthritis in the neck and he swore by Celebrex. Made him pain free but he changed doctors and he threw it in the bin saying he could not take it with his heart condition. Then he was back in pain again but panadol osteo helped a bit.

    • Turmeric capsules work well, it takes a while to get into your system but does help and is natural. There is a lot of scientific evidence that proves turmeric works. By reducing food that causes inflammation to the body like bread also helps.

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      • I like to try anything natural first. I used a poultice with ground up Comfrey root mixed with oil on a torn Achillies tendon, 10 days later it was completely cured!

  3. I only take prescribed medicine, I never take over the counter preparations, my doctor is the expert, I only take what he prescribes

  4. I have taken Orudis (keptoprofen) every day for the past 15 years for oesteo-arthritis and so far, so good. Pain excellent (I have trialled other medication).

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  5. If these drugs are dangerous why are they being sold?

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    • Pretty simple really Bindy. Just take a look at the bottom line of the pharmaceutical companies that make the drugs – that will explain why. It is all about $$$’s.

  6. Whilst they did work for me, the damaged liver as a result of years of prescription anti inflammatories did not! Daily hydrotherapy (30 – 60 mins) works well and has me using my severely damaged knee joints quite effectively.

  7. When I studied my first Degree many years ago I learnt that Australia allows many drugs into Australia which they will not use in America OR NZ. Not sure but could it be for financial gain & to get rid of people. Governments aren’t opposed to killing people off, look how the FIRST AUSTRALIANS were treated, & still are….appalling I say

  8. Can buy it at the local supermarket, but if i want to buy it at the local pharmacy you have to speak to the Chemist first. No problem there but why is it being sold in a supermarket?

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