Diclofenac is Anti-Inflammatory Medication
Diclofenac is a member of non-steroidal anti-inflammatory drugs (NSAIDs), a group of highly potent anti-inflammatory agents which are prescribed in various conditions. Apart from acting against inflammation NSAIDs, including diclofenac can relieve pain of sometimes even excruciating character.
The drug is in the UK, India, Brazil and the USA manufactured as sodium or potassium salt. Other countries produce either of the two. Even though diclofenac is basically prescribed in some countries the drug is available over-the-counter when used to treat mild aches and pains as well as fever due to some common infections. One information worth of mentioning is external use of the gel containing the active substance (diclofenac 1% gel). The gel is prescribed to individuals with musculoskeletal conditions.
The main medical use of the drug is alleviation of pain due to various conditions. Diclofenac is also indicated in inflammatory disorders while in women the drug may be highly efficient against dysmenorrhea (severe pain during menstruation that interferes with every day activities).
Inflammatory conditions affecting musculoskeletal system can precipitate excruciating pain due to inflammation and subsequent damage to various structures including bones, joints, muscles etc. By using diclofenac the inflammation subsides and pain may be completely brought under control. This is confirmed in individuals suffering from various types of arthritis, polymyositis, dermatomyositis, ankylosing spondylitis as well as spondyloarthritis.
Furthermore, diclofenac is a powerful tool against dental pain, pain associated with temporomandibular joint disorder and pain caused by kidney/gallstones or gout attack.
Even people suffering from migraines may sometimes benefit from the drug although diclofenac is not routinely prescribed in this purpose.
Sometimes diclofenac is administered postoperatively or when pain occurs due to some trauma, especially if there is associated intense inflammation.
And finally, the drug may alleviate menstrual pain or pain connected to endometriosis.
Since diclofenac increases the chances of peptic ulcer development, patients who are supposed to take the drug for a long period of time as well as susceptible individuals are additionally prescribed misoprostol, an agent that protects gastric and duodenal mucosa from detrimental effects of stomach acid.
One of the most severe types of pain is definitely cancer-related pain. Patients suffering from certain types of cancer, especially those with bone metastases may respond well to diclofenac. As a matter of fact the drug is a part of the WHO recommendation scheme for treatment of chronic pain. So, before opting for opioids patients should try diclofenac. Sometimes doctors recommend the combination of the two (diclofenac and opioids), if it is necessary. For instance, European patients may receive Combaren which is a fixed combination of diclofenac and codeine.
One more potential used of diclofenac is fever associated with Hodgkin's lymphoma. The drug seems to be efficient against multi drug resistant E. coli strains but this efficacy of diclofenac requires further research.
Finally, diclofenac may easily increase blood pressure in patients suffering from Shy-Drager syndrome and diabetes mellitus. Therefore, they are not routinely prescribed the drug.
Side Effects of Diclofenac
Diclofenac is definitely one of the most well-tolerated members of NSAIDs. However, it has certain side effects most of which occur when the drug is used for a long period of time. It is estimated that 20% of patients who are on long-term treatment eventually develop some side effects. They mostly complain about gastrointestinal problems.
Diclofenac has many side effects all of which are classified into cardiac, gastrointestinal, hepatic, renal and other adverse effects.
When it comes to cardiac side effects the most serious one is an increased in risk of heart attack. Such risk is, however, small and most patients are recommended to continue taking the drug because its benefits do surpass the risk of heart attack. There were even studies which practically confirmed no connection between diclofenac and myocardial infarction. Still, the majority of conducted studies do say that the risk is present but is not actually high.
Gastrointestinal side effects of diclofenac are the most reported. When one develops peptic ulcer or there is gastrointestinal bleeding, diclofenac is instantaneously discontinued. Because peptic ulcers are expected side effects of diclofenac most patients receive another drug efficient against stomach acid which protects the surface of the stomach and duodenum and prevents this complications from occurring.
As for hepatic complications there is irreversible liver damage as the most frequent one. In rare instances patients may develop hepatitis. The liver inflammation is sometimes fatal causing lethal outcome. Hepatotoxicity is generally reported in long-term treatment and is more common in patients with osteoarthritis. When diclofenac is indicated for a long period of time, liver function tests are performed on a regular basis.
According to various studies NSAIDs may precipitate renal adverse effects due to the reduction in synthesis of renal prostaglandins. This is especially reported in sensitive individuals and those who use the drug for the extended period and are not sensitive.
In the end, rare complications associated with diclofenac intake include bone marrow depression and the accompanying leucopenia, agranulocytosis, thrombocytopenia and aplastic anemia.
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