A personal story about a medication

In May and June of 2022, I had both knees replaced. I was given a prescription for diclofenac, a non-steroidal-anti-inflammatory (NSAID) and instructed to take one each morning and evening. I took only two or three, so had a lot left over. Lately, I’ve discovered that they are a great pain reliever for my sciatica, so I started taking them several times a week.

When researching the side effects of that drug, I came across research conducted by Washington State University College of Pharmaceutical Sciences that investigated the fact that, for some people, diclofenac causes heart damage. In the U.S., diclofenac could be purchased over the counter until 2013, at which time the FDA restricted it to prescription-only because of the heart damage reports. Nevertheless, more than 10 million prescriptions for diclofenac are written every year in the U.S., and it is one of the most widely used NSAID drugs worldwide, including countries in Asia, Africa, and the Middle East where it can be purchased without prescription.

I wrote to Bhagwat Prasad, one of the lead researchers. He wrote back. Here are excerpts from our several email exchanges. I began by introducing myself and explaining my history of taking diclofenac, after which I add the following sentences:

Me: Is there a way I can find out if I am one of those for whom diclofenac can cause heart problems? Diclofenac is the only medication I take.

Bhagwat: Our study suggests that individuals who don’t carry UGT2B17 gene are prone to higher levels of diclofenac in blood and risk to greater toxicity after oral administration. However, there are many factors that affect safety of diclofenac in different people.

Me: Since last writing to you, I had an MRI and learned that I have “severe spinal stenosis” (L4-L5). Painful sometimes. I do lots of stretching and exercising. Diclofenac is a big help.

I signed up with 23 and Me when the company first got started. I’ve contacted them and was able to search my raw data. I got the following response: “No genes or markers found matching UGT2B17.” I guess that’s bad news, but good to know. I’ll keep taking diclofenac on golf days anyway. It works.

Bhagwat: Thank you so much for these updates. First, I should thank you for taking care of yourself and prioritizing your health. You have become my role model! This is all very impressive that you have 23andMe data available for you to consider when taking medicine. [He goes on to recommend sharing this information with my physician and reducing the dose, etc.]

Me: I want to share a bit of alarming information from a book I read recently, called From Here to Eternity, by Caitlin Doughty. The book describes various ways in which different peoples from around the world deal with death. In Mumbai, the Parsis build platforms on which they place their dead bodies for vultures to devour. Doughty writes, “The vulture population has dropped 99 percent. In the early 1990s, India allowed the use of diclofenac (a mild painkiller similar to ibuprofen) for ailing cattle. Hoof and udder pain were eased, but when the animal perished and the faithful vultures soared down for the meal, the diclofenac caused their kidneys to fail.”

Are you familiar with this? As you can imagine, that paragraph caught my attention!

Bhagwat: Yes, I am aware of the vulture being vulnerable to extinction with diclofenac use. It’s a huge man-made disaster as we are killing the scavengers. The problem has recently been noticed in Spain and UK as well. Diclofenac causes vasoconstriction and damages kidneys of vultures. There are multiple reports of kidney related problems of diclofenac in humans with chronic use. [So far, email exchanges end here.]

Maybe I shouldn't even take diclofenac on golf days.

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