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Diclofenac OTC switch confounds efforts to cut NSAID use

By Lilian Anekwe

Exclusive: Efforts to reduce the prescribing of NSAIDs are being threatened by the rise in sales of over-the-counter diclofenac, a Pulse investigation shows.

Pharmacy sales of oral diclofenac have shot up to almost one million a year since the UK drug regulator made it available for sale over the counter, but GP prescriptions have only fallen slightly.

Overall use of diclofenac has risen by 5.6%, and our analysis shows that the rise in sales of packets of diclofenac over the counter has occurred at twice the rate that GP prescriptions have fallen.

The rise in diclofenac use comes despite a 2006 MHRA bulletin which discouraged GPs from using diclofenac after estimates that – when prescribed at high doses over a number of years – it could be responsible for up to 2,500 additional or premature myocardial infarctions a year in England.

Figures obtained by Pulse from Cegedim Strategic Data show GPs issued an average of 7.4 million prescriptions for diclofenac every year in the three years leading up to the reclassification in September 2008.

In the year after diclofenac become available OTC, GPs issued just over seven million prescriptions – a decline of 396,000 and a reduction of just 5.64%.

But when combined with over-the-counter sales of 813,000 packets, overall use has increased, with 417,000 more packets of diclofenac in circulation in the year after the drug was reclassified, according to figures provided by market analysts Information Resources.

Dr Ross Duff, a GPSI and clinical assistant in rheumatology in Angus, Tayside, said: ‘The reason given for the over-the-counter switch was to reduce appointments and prescriptions but we've noticed very little difference in my practice and from your figures it seems to have increased overall use.

‘That's slightly worrying because it goes against what we're trying to teach people which is to reduce NSAID usage. Diclofenac is certainly not a drug I would start treatment with. I would have concerns because of renal and gastric complications.

We have absolutely no control over what people are buying over the counter and have to hope there are some checks at the pharmacy.'

The switch of diclofenac to OTC has confounded efforts to cut NSAID use

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