Prescribing patterns of diclofenac in patients with risk or at high risk for cardiovascular diseases in outpatient care settings in Montenegro

Background/Aim. Diclofenac, a non-selective inhibitor of cyclooxygenase, with analgesic, anti-inflammatory and antipyretic effects, is one of the most prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to analyse prescribing patterns of diclofenac systemic formulations at the outpatient care settings (OCS) in Montenegro, in patients with cardiovascular (CV) disease (CVD) and patients with risk factors for CVD, during the period 2016-2020. Methods. The retrospective, national, drug utilisation study, included patients with CVD, to whom prescribing of diclofenac is contraindicated and patients with risk factors for CVD, for which diclofenac can be prescribed, but with increased precaution. Primary health care information system (PHCIS) has been used as source of medical data for these patients. Results. Within the observed period, prescribing and consumption of diclofenac systemic formulations, dominantly oral formulations in 75 mg dose, increased by 36.9 % (from 4.6 of defined daily doses (DDD) /1,000 inhabitants/day in 2016 to 6.3 DDD/1,000 inhabitants/day in 2020). The rising trend in prescribing diclofenac was also noted in patients with CVD/ risk factors for CVD, for which diclofenac prescribing is contraindicated/precautioned. Out of the overall number of patients who were prescribed diclofenac in 2016, 2017, 2018, 2019 and 2020, 16%, 18%, 24%, 15% and 20% of them, respectively, had a CVD/ risk factor for CVD. The highest number of CV patients (39.7%), who were contraindicated for prescribing of diclofenac, had ischemic heart disease (they had been prescribed 40.7% DDD/1,000 inhabitants/day of diclofenac of overall prescribed medicine for this group of patients). The highest number (77.4%) of patients who could be prescribed the drug, but with increased precautions, had hypertension and they were prescribed in 77.2% of DDD/1,000 inhabitants/day of diclofenac of overall prescribed drug for this group of patients. Conclusion. Despite undertaken regulatory measures aimed at safer prescription of diclofenac to patients with CVD or risk factors for CVD, this medicine is still widely prescribed, even in cases representing contraindications for its use.