NSAIDs ranked according to risk with naproxen coming in safest

A “HIERARCHY of risk” is emerging for NSAIDs, with naproxen deemed safest while diclofenac increased a patient’s cardiovascular (CV) risk even at OTC doses, experts say.

Diclofenac was ranked alongside the now withdrawn rofecoxib as carrying the highest overall increased CV risk – 40% – in the systematic review co-authored by pharmacologist Dr David Henry, from the universities of Newcastle and Toronto.

The review of 51 studies including 2.7 million patients and 180,000 CV events, found naproxen was “risk neutral at all doses”.

“The data here suggest that naproxen is superior to ibuprofen in terms of cardiovascular safety,” the authors said.

“To our knowledge this is the first evidence to show a significant difference between the two drugs.”

Ibuprofen carried no risk at doses below 1200 mg/d but patients at high background CV disease risk should be warned off