A study in Denmark has linked the significant rise of cardiac arrests with the consumption of popular, over-the-counter painkillers such as ibuprofen and diclofenac. The findings of the study published in the European Heart Journal on 15 March 2017 has called for tighter sales restrictions of the drugs.

The non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common drugs used worldwide as they are easily obtained. In Singapore, ibuprofen is classified as a General Sale List (GSL) medicine, provided it is sold in tablets or capsules containing not more than 200mg of the drug, or in syrup of 100mg/5ml, according to the website of the Health Sciences Authority. GSL products can be freely obtained from any retailer.

“Stark reminder that NSAIDs are not harmless”

Professor Gunnar Gislason of the University of Copenhagen and his team studied data on all patients in Denmark who had a cardiac arrest outside of the hospital between the years 2001 and 2010. Of the 28,947 patients, 3,376 had been treated with an NSAID up to 30 days beforehand. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use respectively.

The research concluded that ibuprofen could increase the likelihood of cardiac arrest by 31%. Diclofenac, available over the counter in the UK until 2015 and still taken on prescription, raised the risk by 50%.

Gislason called the findings a "stark reminder that NSAIDs are not harmless" and said ibuprofen and similar drugs should only be sold in pharmacies, in limited quantities and in low doses.

“I don't think these drugs should be sold in supermarkets or petrol stations where there is no professional advice on how to use them,” he said.

Diclofenac to be avoided as it is the riskiest NSAID

Gislason urged people with heart problems to avoid ibuprofen and other NSAIDs. “NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors,” he said.

The drugs exert numerous effects on the cardiovascular system, such as influencing platelet aggregation and the formation of blood clots. They may also cause arteries to constrict, increase fluid retention and raise blood pressure.

“Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” he said.

However, the trade body representing manufacturers of over-the-counter medicines, Proprietary Association of Great Britain, said the study had “several limitations” and insisted that NSAIDs are safe.

John Smith, chief executive of the trade body, said, “Information about daily dosage was only based on estimates rather than accurate data and didn’t account for over-the-counter use.”

Smith explained that NSAIDs under prescription normally contain a higher dosage than those available over-the-counter and are typically taken over longer durations.

Gislason said that patients should be reminded to not take more than 1,200mg of ibuprofen in one day. He also cautioned against using diclofenac, suggesting that patients should look for safer alternatives.

“Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population,” he said. “Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac.” MIMS

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