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Call for ibuprofen sale to be restricted to pharmacies following cardiac concerns

Researchers have called for over-the-counter sales of ibuprofen to be restricted to pharmacies, after finding the NSAID raised the relative risk of cardiac arrest ‘by 31%’.

The team from Denmark looked at prior NSAID use in nearly 30,000 people who suffered an out-of-hospital cardiac arrest between 2001 and 2010, based on what prescriptions they redeemed.

Over 3,000 of these people had been treated with an NSAID up to 30 days before the event, with ibuprofen and diclofenac the most commonly used.

By comparing what NSAIDs people used during the pre-cardiac arrest period with what they used in an earlier 30-day period, the researchers found that use of any NSAID was associated with 31% increased odds of cardiac arrest.

Breaking it down further showed diclofenac increased the odds of cardiac arrest by 50% and ibuprofen by 31%.

As each patient served as both case and control over the two different time periods, any confounding effects from comorbidities was minimised, the researchers claimed.

And, although they could not account for additional use of over-the-counter ibuprofen - which, as in England is the only NSAID widely available over the counter in Denmark - they said any underestimation of how much of this NSAID people used should be equally distributed between the two periods.

As a result, lead author Professor Gunnar Gislason, professor of cardiology at Copenhagen University Hospital Gentofte, said: ‘I don’t think these drugs should be sold in supermarkets and petrol stations where there is no professional advice on how to use them.’

'Over-the-counter NSAID should only be available at pharmacies, in limited quantities, in low doses.’

Professor Gislason added: ‘Do not take more than 1,200 mg of ibuprofen per day. Naproxen is probably the safest NSAID and we can take up to 500 mg a day. Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population.’

It comes after the European drugs regulator warned GPs to check patients cardiovascular risk before issuing long-term prescriptions of ibuprofen. Diclofenac has been removed from pharmacy sale in the past two years.

The research is published in the April print issue of European Heart Journal - Cardiovascular Pharmacotherapy.

Eur Heart J - Cardiovasc Pharm 2016; Available online 24 December  

 

 

 

 

 

Readers' comments (2)

  • Pain control is really becoming challenging.
    Many analgesic options out of reach due to cost or side effects. Pain clinics are largely ineffective.
    MDT type approach is expensive.
    Pain psychology input waiting times are months if not a year...

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  • Ivan Benett

    Remember also interaction with ACEIs and nephrotoxicity. But also need to balance risk with benefit for each individual, they may prefer to take an informed risk.

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