From the Guidelines
Aspirin and diclofenac are contraindicated in patients with a history of gastrointestinal bleeding, severe heart failure, and hypersensitivity to either drug or other NSAIDs, as well as in those with active peptic ulcer disease, due to the significant risks of adverse effects as outlined in the study by 1. The major contraindications of aspirin and diclofenac can be summarized as follows:
- Active peptic ulcer disease
- History of gastrointestinal bleeding, with a one-year risk of one in 2,100 adults younger than 45 and one in 110 adults older than 75, as reported in the study by 1
- Severe heart failure, due to the potential for worsening hypertension, myocardial infarction, and other cardiovascular complications, as noted in the study by 1
- Hypersensitivity to either drug or other NSAIDs
- Aspirin is specifically contraindicated in:
- Children under 16 years with viral infections due to the risk of Reye's syndrome
- Patients with hemophilia or other bleeding disorders
- During the third trimester of pregnancy, as stated in the study by 1
- Diclofenac should be avoided in patients with:
- Established cardiovascular disease, cerebrovascular disease, peripheral arterial disease
- Moderate to severe kidney impairment
- Inflammatory bowel disease
- Both medications are contraindicated in patients with severe liver impairment and should be used with caution in asthmatics due to the risk of bronchospasm, as indicated in the study by 1. These contraindications exist because these NSAIDs inhibit prostaglandin synthesis, which can worsen gastric mucosal protection, renal perfusion, and platelet aggregation, as explained in the study by 1. Additionally, they may increase cardiovascular risk through effects on thromboxane-prostacyclin balance, particularly important in patients with pre-existing cardiovascular conditions, as noted in the study by 1.
From the FDA Drug Label
Diclofenac potassium tablets are contraindicated in the following patients: Known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to diclofenac or any components of the drug product History of asthma, urticaria, or allergic type reactions after taking aspirin or other NSAIDs. In the setting of coronary artery bypass graft (CABG) surgery
The major contraindications of diclofenac are:
- Hypersensitivity to diclofenac or its components
- History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs
- Coronary artery bypass graft (CABG) surgery For aspirin, the provided drug labels do not directly answer the question, however, it can be inferred from the contraindications of diclofenac that aspirin has similar contraindications, including:
- Hypersensitivity to aspirin
- History of asthma or allergic reactions after taking aspirin or other NSAIDs 2
From the Research
Contraindications of Aspirin
- A history of peptic ulcer disease or gastrointestinal bleeding 3, 4, 5, 6, 7
- Older age 5, 7
- Concomitant use of NSAIDs, including coxibs 4, 5, 7
- Concomitant use of anticoagulants or other platelet aggregation inhibitors 4, 5, 7
- The presence of severe co-morbidities, such as chronic renal failure 7
- High aspirin dose 5
- Helicobacter pylori infection 3, 6, 7
Contraindications of Diclofenac
- No specific information is available in the provided studies regarding the contraindications of diclofenac. However, as a nonsteroidal anti-inflammatory drug (NSAID), it is likely to have similar contraindications as aspirin, including a history of peptic ulcer disease or gastrointestinal bleeding, older age, concomitant use of other NSAIDs or anticoagulants, and the presence of severe co-morbidities 4
Common Contraindications
- Patients with a history of gastrointestinal bleeding or peptic ulcer disease should be cautious when taking aspirin or diclofenac, and may require prophylactic treatment with proton-pump inhibitors or other gastroprotective agents 4, 6
- Patients taking concomitant medications, such as anticoagulants or other NSAIDs, should be closely monitored for signs of gastrointestinal toxicity 4, 5, 7