Evaluating diclofenac's risks in COVID-19: strategies for mitigating adverse outcomes

The use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac, during the COVID-19 pandemic has raised concerns due to its potential to worsen disease progression. This commentary evaluates key risks associated with diclofenac and highlights the critical role of pharmacists in mitigating adverse outcomes through careful medication management and patient education. Diclofenac poses unique risks due to its ability to generate reactive oxygen species (ROS), leading to oxidative stress and mitochondrial dysfunction. In COVID-19, a disease characterized by hyperinflammation, these effects may exacerbate systemic inflammation, contributing to severe outcomes. Moreover, diclofenac's known association with increased cardiovascular risks, such as myocardial infarction and stroke, is especially concerning in patients with COVID-19, who are predisposed to thrombotic complications. The drug's hepatotoxic potential adds another layer of concern, particularly in patients with pre-existing liver dysfunction or those at higher risk due to COVID-19-related liver involvement. Pharmacists play a pivotal role in addressing these risks by conducting thorough medication reviews and assessing patient-specific risk factors. They can guide clinicians and patients toward safer alternatives, such as ibuprofen or naproxen, which demonstrate a lower oxidative and cardiovascular burden. Patient education is equally critical; pharmacists should counsel individuals on potential adverse effects of diclofenac, such as cardiovascular symptoms, renal dysfunction, and liver complications, while advising on lifestyle modifications and adjunctive therapies to reduce NSAID dependence. Additionally, pharmacists contribute to pharmacovigilance by monitoring patients for adverse drug reactions and reporting safety concerns to improve NSAID usage guidelines during the pandemic. By adopting a personalized approach to NSAID therapy, pharmacists can minimize risks and enhance patient safety, ultimately improving outcomes in the management of COVID-19 and other inflammatory conditions. This underscores their indispensable role in optimizing care during complex clinical scenarios.