Heart failure diclofenac

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

In a randomized comparison of celecoxib and diclofenac plus omeprazole, renal adverse events, including hypertension, peripheral edema, and renal insufficiency, were common and similar in the two groups (105). They occurred in the 24% of the patients who took celecoxib and in 31% of those who took diclofenac plus omeprazole. Among patients with renal impairment at baseline, 51% of those who took celecoxib and 41% of those who took diclofenac plus omeprazole had renal adverse events. Careful monitoring of renal function in patients taking COX-2 inhibitors or traditional NSAIDs is mandatory, especially in high-risk subjects (for example those with pre-existing renal disease, diabetes, or heart failure). 

A study in patients with heart failure and cirrhosis found that diclofenac 150 mg daily reduced the furosemide-induced excretion of sodium by 38%, but the excretion of potassium was unaltered. ... 

An otherwise healthy 59-year-old woman developed extreme sinus bradycardia (30 bpm) with chest pain and acute right heart failure while taking tizanidine, diclofenac and rofecoxib. This resolved promptly after stopping the medication. Note that rofecoxib was generally withdrawn worldwide in 2004 because of its cardiovascular adverse effects, but these data are included here for completeness. 

Juhlin, T., S. Bjorkman, B. Gunnarsson, et al. 2004. Acute administration of diclofenac, but possibly not long term low dose aspirin, causes detrimental renal effects in heart failure patients treated with ACE-inhibitors. Eur.). Heart Fail. 6(7) 909-916. 

Long-term administration of NSAIDs can result in renal papillary necrosis and other renal injury. Diclofenac should be used with caution in patients at greatest risk, including the elderly, those with impaired renal function, heart failure, liver dysfunction, and those taking diuretics and ACE inhibitors. 

Fluid retention and edema have been observed in some patients taking NSAIDs and therefore diclofenac should be used with caution in patients with a history of fluid retention or heart failure. 

ANTI-INFLVMMATORY AND ANTIPYRETIC ANALGESICS AND DRUGS USED IN GOUT TABLE 2 Effects of COX-2 Selective Inhibitors, Naproxen, Diclofenac and Ibuprofen on Major Vascular Events, Heart Failure Hospitalization, All-Cause Mortality and Upper Gastrointestinal Complications ... 

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