Can Diclo (Diclofenac) be given in a hypertensive crisis?

From the Guidelines

Diclofenac (Diclo) should not be given during a hypertensive crisis. NSAIDs like diclofenac can worsen hypertension by promoting sodium and water retention, increasing peripheral vascular resistance, and inhibiting the production of vasodilatory prostaglandins 1. In a hypertensive crisis, where blood pressure is dangerously elevated (typically >180/120 mmHg with evidence of end-organ damage), diclofenac could further elevate blood pressure and potentially increase the risk of complications such as stroke, heart attack, or kidney damage.

The appropriate management of hypertensive crisis involves rapid-acting antihypertensive medications like labetalol, nicardipine, clevidipine, or sodium nitroprusside administered in a monitored setting 1. The 2019 European Heart Journal study provides guidance on the management of hypertensive emergencies, including the use of labetalol, nitroprusside, and nicardipine as first-line treatments 1.

If a patient with hypertensive crisis requires pain management, alternatives to NSAIDs such as acetaminophen or carefully titrated opioids under close monitoring would be more appropriate. Patients with a history of hypertension who regularly take diclofenac should be aware that it may contribute to blood pressure elevation and should monitor their blood pressure regularly. Key considerations in managing hypertensive crisis include:

• Rapid blood pressure reduction using intravenous antihypertensive medications
• Close monitoring of blood pressure and organ function
• Avoidance of NSAIDs and other medications that may worsen hypertension
• Use of alternative pain management strategies when necessary.

From the FDA Drug Label

NSAIDs, including diclofenac potassium tablets can lead to new onset of hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events Monitor blood pressure (BP) during the initiation of NSAID treatment and throughout the course of therapy

Diclofenac is not recommended in a hypertensive crisis. The FDA drug label warns that NSAIDs, including diclofenac, can worsen preexisting hypertension and lead to new onset of hypertension, which may contribute to increased CV events. Therefore, it is not advisable to give Diclo (Diclofenac) in a hypertensive crisis. 2

From the Research

Hypertensive Crisis Management

The management of hypertensive crises involves the reduction of blood pressure to prevent target organ damage.

• Hypertensive emergencies require immediate reduction of blood pressure with intravenous antihypertensive agents, such as labetalol, esmolol, fenoldopam, nicardipine, and clevidipine 3, 4, 5.
• Hypertensive urgencies can be treated with oral antihypertensive agents, with the goal of reducing blood pressure within 24 hours 3, 4, 5.

Diclofenac in Hypertensive Crisis

There is no direct evidence in the provided studies regarding the use of Diclofenac (Diclo) in hypertensive crises.

• The studies focus on the management of hypertensive crises with antihypertensive agents, and do not mention the use of Diclofenac in this context 3, 4, 5, 6, 7.
• Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID), and its use in hypertensive crises is not addressed in the provided studies.

Antihypertensive Agents

The studies discuss the use of various antihypertensive agents in the management of hypertensive crises, including:

• Sodium nitroprusside, which is considered toxic and should be avoided 3, 4, 5.
• Labetalol, esmolol, fenoldopam, nicardipine, and clevidipine, which are considered suitable for use in hypertensive emergencies 3, 4, 5.
• Hydralazine, nifedipine, and nitroglycerin, which are not recommended as first-line therapies due to their toxicities and side effects 3, 4, 5.