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Pharmacists to sell diclofenac

By Lilian Anekwe

Diclofenac is to become the latest high-profile drug to be made available over the counter in a move that has raised consternation among some GPs.

Diclofenac is to become the latest high-profile drug to be made available over the counter in a move that has raised consternation among some GPs.

The Medicines and Healthcare Products Regulatory Agency has announced that from next month patients will be able to purchase diclofenac 12.5mg OTC for a wide range of indications including headaches, period pain and symptoms of cold and flu.

The agency also confirmed that another NSAID, naproxen, has been reclassified from prescription only to available OTC, for the treatment of primary dysmenorrhoea – a move that could ease GPs' workload.

But it is the decision to reclassify diclofenac that has most raised eyebrows, coming just two weeks after Pulse revealed controversial moves to make trimethoprim available without prescription.

In 2006 the MHRA advised GPs to use either naproxen or ibuprofen first line, after estimates that diclofenac - when prescribed at high doses over a number of years - could be responsible for up to 2,500 additional or premature myocardial infarctions a year in England.

Dr John Dickson, community specialist in rheumatology for Redcar and Cleveland PCT and a member of the NICE osteoarthritis guideline development group, said the move ‘doesn't fit at all' with the recent NICE osteoarthritis guidance, which recommends anyone taking an NSAID should also be prescribed a proton pump inhibitor.

‘It leaves us with the possibility patients could be taking two NSAIDs, ibuprofen and diclofenac and possibly a third, naproxen, without ever having seen their GP', he added.

Dr Maureen Crown, a GP in South Woodford, London, said: ‘Why make it OTC when you have drugs like ibuprofen – why have another one?'

But Dr Neal Maskrey, director of evidence-based therapeutics at the National Prescribing Centre, said: ‘The MHRA's decisions relate to very low doses of diclofenac or naproxen and for short-term use only.

‘The balance of risks and benefits of that decision must be positive based on the data I've seen. Personally I'd still buy ibuprofen and naproxen before diclofenac OTC, even though I accept the individual cardiovascular risk increases with low doses, and with short-term diclofenac is probably close to zero.'

A spokesperson for the MHRA said: ‘The MHRA only makes prescriptions medicines available over the counter where it is safe to do so.'

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