Can I Insist On My Diclofenac?

Doc wrote to me, saying my repeat prescription for Diclofenac would not be continued. I only use approx 10 tablets a month (as Doc would know from re-order frequency) as I only take them when I really need to for arthritic bouts in my ankle, knees and arm. I'm fit (otherwise) have good BP and low pulse. Been to Doc and put me on Paracetomol & Co-Codomol -I'm not expecting it to be of much use as paracetomol on its own has never done much. I tried Naproxin previously and I had mouth ulcers and, strangely - hair loss. All stopped when I came off it and back on Diclo.

Diclofenac just works for me, I don't overdo it - Could this be a cost cutting exercise?? Do I have any rights to insist on this product? What do I do if the pain killer prescribed does not work for me?

18 Replies

  • I agree diclofenic works for me naproxen useless, I think you have the choice. Let me know what doc says? I use approximate same as you and use losec for tummy.

  • Hi, thanks for your reply.

    I've had a chance to test it now, and whereas I used to take 1 Diclofenac a day, I now take 8 Cocodemol/Paracetomol a day. Less effect by far, and surely more for my system to process.

    Are you still on Naproxen? They did work, but side effects (or coincidence who knows...) for me. If you are back on Diclofenac, how did you get back on them please?

  • Did Doc say why? And was he/she saying no to Diclofenac or to all NSAIDs? Diclo has had some bad press recently, so some people have aksed to try another. But esp if your blood pressure good, and haven't got high cholesterol seems a bit mean to ban all anti-inflammatories unless worried about your stomach perhaps? There are loads of them, so perhaps worth asking again and saying that you understand the risks but feel you need something stronger than just painkillers to keep your quality of life. Px

  • Thanks - No Doc didn't say why. We never get to see the same Doc twice, I don't bother any of them too much - but I got the distinct impression that when I said I had tried Naproxen before (it would have been on my notes of course) but that I had possibly had side effects - she became irritated as if I'd removed the last option available to her and said I should take she was typing out the prescription. She asked if I was sure I had got mouth ulcers as a result of taking Naproxen... I said I wasn't sure but they had disappeared after stopping Naproxen and I'd never really suffered with them before - Ditto hair loss. At 53 I suppose I could have expected hair loss, but it was coming out in the bath hair wash and has stopped thinning since. Co-incidence it may be, how would I know. Naproxen did seem to work as Diclofenac otherwise, and the leaflet did list these (and tons of other) side effects. Diclo lists lots of side effects, but I've not been aware of any myself.

  • I can't understand why your GP wouldn't explain the reason behind this decision to you at least? They might not be keen to tell you because it's down to budget in which case I really think you should go back and just ask them to be straight with you about their reasoning. I don't know the rules re NHS good practice but I am sure you have a right to see your notes and get to the bottom of their decision. Co-codimol isn't an anti-inflammatory so would not be effective alone for inflammatory arthritis/ RA. If Naproxen gives you side effects where Diclofenac doesn't then it seems like very skewed thinking to me and I think you are owed an explanation that will hopefully reverse their decision. TT

  • Thanks TildaT!

    If I took the drug daily I could understand it - I don't need to, and haven't - Typical users who take it regularily would probably have an issue. My doctor(s) seem to have flagged everyone that has a repeat prescription and blanket stopped it. They could be doing me a favour, but quality of life comes into this doesn't it? I don't want to be in pain till I'm a 100 but not dead of a stroke - Give me good quality of life where I can carry on my hobbies and activities and peg out at 75/80 if thats realistic.

    Does anyone out there use something other than Diclofenac or Naproxen I could try? Ibuprofen does work but its not strong enough.

  • Hi again Ian. Are you on a DMARD I wonder? If so this and if this was working at controlling the disease successfully then I'm told that this should replace NSAIDs at some stage. Have you tried Tramadol? I haven't tried it myself yet although I do have some now and my GP asked me today how I had found it. She said there are several other pain killers and anti-inflammatories but I think Naproxen and Diclofenac are the main ones used in RA and paracetamol, codeine and tramadol are the ones most used as pain relief.

    You maybe need to stick to one GP in your practice for most of your healthcare and that might make it easier to build up a relationship so you can ask more easily about these things? TT

  • Hello TildaT,

    Very good point re Doctors and sticking to one - I don't often go, but when I do I ask for an appointment they just allocate a doctor to see me. They have asked me before if I want to see anyone specific and I've said no, usually because I want the first available appointment. Mmm, great idea...

  • Ps also worth considering taking oral steroids or getting an injection because if you are taking a lot of anti-inflammatories and analgesics then these can have more side effects than a steroid injection being administered from time to time my GP told me?

  • Is the steroid injection area specific I wonder, I get this in several places - not disabling but uncomfortable, and depends on what activity I've been doing. ie walking its my ankle etc etc

  • There's one called Meloxicam (or Meloxipam? I forget which). Or there are the Cox-2 inhibitors. If you don't see same doc each time then I'd be tempted to book another appt and say that you're keep getting swollen joints and co-codamol doesn't help, and so really really want something to tackle inflammation as well as pain. Personally I'm a steroid jab fan as that's what works for me.

  • Thanks HelixHelix, I'll look into those. Steroid injection could do for my ankle, but I'd have more steroid than Jordan has silicone if all my aches were to be done that way!

  • Just checking Ian - you don't say anything about what you have but since you re here you do have RA I take it? Do you see a rheumatologist and what do they say about medication if so? If you aren't yet diagnosed then it's doubly important that you go to see one GP who can get to know you better and refer you if necessary - and stop seeing yourself as time wasting or not wanting to bother doctors - that's their job!

  • I think you should have a chat with your gp about ther decision. it may well be a "blanket" decision ,my health authority arent prescribing it as much as it is deemed to put people at higher cardiovascular risk than some of the other more common NSAID ( non steroidal anti inflammatory drugs).

    Different drugs suit different people I chose etorocxib(arcoxia) a cox 2 inhibitor as my anti inflammatory ( kinder on the gut!) this too gives an increased risk of adverse cardiac events.../ thrombotic events to the same degree of diclofenac. Naproxen and ibuprofen are deemed the safest cardiovacularly

    Your Gp is the best person to adviser as he knows your full medical history.

    It is always safest to use the lowest dose of your chosen drug to control symptons and for the shortest time, the need for long term treatment should be reviewed periodically.

  • Yes I see, I just can't think what the Doc is basing all this on. As long as its specifically my health, not budgets, and a suitable alternative is offered or at least discussed then I will feel part of the process. I'd like to think that somewhere along the line I was allowed to consider the risk/benefit argument

  • Hi there has been some recent concern about cardiac risks in those taking diclofenac so all gp's have been encouraged to change patients to an alternative- usually naproxen or ibuprofen.

    Your gp really should have seen you to explain why so i would make an appointment to discuss it.

    Having informed you of the risks and that being documented, he may then agree to a script, or maybe you could try an alternative with the agreement that you review things in a month ?

    If only they gave the right information at the time of change it would make life less stressfull for all!

  • Yup, I did have an appointment but it was a bit one sided about the treatment offered - I started this thread because I'm not sure where I stand in requesting an alternative (or the same drug come to that). Lots of kind contributors here have suggested other drugs and ideas's - Time to go and check it out and then have another meet I reckon, which doc is most sympathetic to this I'm not sure - as pointed out by TildaT, I need to concentrate more effort on building a relationship with 1 doctor instead of the whole practice.

    Thanks all - I'll report back in the fullness etc...

  • Trouble is that it's a bit of difficult question as docs differ - guess they're human too! Some seem to respond well when you've taken the time/trouble to inform yourself about disease, drugs and so on - which they should do as it's supposed to be important for RA that we inform ourselves. But others seem to be stuck in the Doc=God era and get snippy as they think you're telling them what to do. But I guess if you know more about what you're looking for then at least it'll help you ask more questions. Keep on pushing - it's your body & your pain (sadly) Polly

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