From the Guidelines
Hifenac P (Aceclofenac) should be used with extreme caution in patients with cardiac conditions, and its use is generally not recommended for patients with established cardiovascular disease, heart failure, or significant cardiac risk factors. The primary concern with using Hifenac P in cardiac patients is the increased risk of cardiovascular events such as heart attack and stroke, especially with prolonged use or high doses, as reported in a study published in 1.
Key Considerations
- The diclofenac component of Hifenac P belongs to the non-steroidal anti-inflammatory drug (NSAID) class, which can increase the risk of cardiovascular events.
- NSAIDs can also cause fluid retention, which may worsen heart failure, as noted in 1.
- Additionally, they can interfere with the effectiveness of some cardiac medications like aspirin, certain antihypertensives, and diuretics.
Alternative Options
If pain management is necessary for a cardiac patient, it's preferable to use paracetamol alone as a safer alternative, as suggested by the guidelines in 1.
Recommendations
Any use of Hifenac P in cardiac patients should be at the lowest effective dose for the shortest possible duration, and only after a thorough risk-benefit assessment by a healthcare provider who is aware of the patient's complete cardiac history and medication regimen, as recommended in 1.
Important Factors
- A healthcare provider should carefully evaluate the patient's cardiac history and medication regimen before prescribing Hifenac P.
- Patients with cardiac conditions should be closely monitored for signs of cardiovascular events or worsening heart failure while taking Hifenac P.
- Alternative pain management options should be considered, and Hifenac P should only be used when the benefits outweigh the risks, as noted in 1 and 1.
From the Research
Cardiovascular Risks Associated with NSAIDs
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cardiac conditions is a topic of concern due to the potential increased risk of cardiovascular events.
- Studies have shown that certain NSAIDs, such as diclofenac and cox-2 inhibitors, are associated with a higher risk of myocardial infarction and cardiovascular death 2, 3, 4.
- The risk of cardiovascular events with NSAIDs is thought to be related to their pharmacological properties, including their ability to inhibit cyclooxygenase (COX) enzymes 5, 6.
- However, the evidence on the cardiovascular risks of NSAIDs is not uniform, and some studies have found that the risk may be lower in patients with high baseline cardiovascular risk 3.
Specific NSAIDs and Cardiovascular Risk
- Diclofenac has been shown to be associated with a relatively higher risk of myocardial infarction, similar to that of rofecoxib 3, 4.
- Ibuprofen has been associated with an increased risk of cardiovascular death, but the risk may be lower than that of diclofenac and cox-2 inhibitors 2, 4.
- Naproxen has been associated with the lowest risk of cardiovascular events among the NSAIDs studied 4.
Use of NSAIDs in Patients with Cardiac Conditions
- The use of NSAIDs in patients with cardiac conditions should be approached with caution, and the risk-benefit balance should be carefully considered 5, 6.
- Patients with a history of myocardial infarction or those at high risk of cardiovascular events should be closely monitored when using NSAIDs 4.
- Alternative analgesics, such as paracetamol, may be considered for patients with cardiac conditions who require pain relief 3.