Diclofenac: Potent Anti-Inflammatory and Analgesic Relief
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Diclofenac is a widely prescribed nonsteroidal anti-inflammatory drug (NSAID) renowned for its efficacy in managing pain and inflammation. It functions by inhibiting cyclooxygenase (COX) enzymes, thereby reducing the production of prostaglandins, which are mediators of pain, fever, and inflammatory processes. Available in multiple formulations including oral tablets, topical gels, and injectable solutions, diclofenac offers versatile treatment options tailored to various clinical needs. It is a cornerstone in the therapeutic management of conditions such as osteoarthritis, rheumatoid arthritis, and acute musculoskeletal injuries.
Features
- Active ingredient: Diclofenac sodium or diclofenac potassium
- Drug class: Nonsteroidal anti-inflammatory drug (NSAID)
- Available formulations: Oral tablets, delayed-release tablets, topical gel, solution for injection, suppositories
- Mechanism of action: Reversible inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes
- Half-life: Approximately 2 hours
- Bioavailability: ~50-60% (oral); variable for topical formulations
Benefits
- Effectively reduces inflammation and associated pain in acute and chronic musculoskeletal conditions
- Provides rapid relief from moderate to severe pain, improving functional mobility and quality of life
- Multiple administration routes allow for personalized treatment strategies based on patient-specific factors
- Demonstrated efficacy in reducing stiffness and improving joint function in arthritic conditions
- Topical formulations minimize systemic exposure, reducing risk of gastrointestinal adverse events
- Cost-effective compared to many newer analgesic and anti-inflammatory agents
Common use
Diclofenac is indicated for the management of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute painful conditions such as sprains, strains, and postoperative pain. It is also used in the treatment of acute gout attacks and dysmenorrhea. Off-label uses include migraine prophylaxis and pain management in certain cancer patients. The choice of formulation depends on the condition being treated, with oral forms typically used for systemic effects and topical forms for localized musculoskeletal pain.
Dosage and direction
Oral tablets (immediate-release): 50mg three times daily or 75mg twice daily for most conditions. Maximum daily dose: 150mg.
Delayed-release tablets: 75mg once or twice daily, or 25mg four times daily.
Topical gel: Apply 4g to affected area four times daily (maximum 32g per day for lower extremities, 16g per day for upper extremities).
Injectable solution: 75mg by deep intramuscular injection, may be repeated after 12 hours if necessary.
Always take with food or milk to minimize gastrointestinal irritation. Do not crush or chew delayed-release formulations.
Precautions
Use with caution in patients with history of gastrointestinal ulceration or bleeding, cardiovascular disease, hypertension, renal impairment, hepatic dysfunction, or asthma. Monitor renal function periodically during long-term therapy. Avoid concomitant use with other NSAIDs. Use the lowest effective dose for the shortest duration possible. Elderly patients may be more susceptible to adverse effects. Topical formulations should not be applied to broken or infected skin.
Contraindications
Hypersensitivity to diclofenac, aspirin, or other NSAIDs. History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Peri-operative pain in coronary artery bypass graft (CABG) surgery. Third trimester of pregnancy. Severe hepatic impairment. Active gastrointestinal bleeding or ulceration. Inflammatory bowel disease.
Possible side effect
Common: Nausea, dyspepsia, abdominal pain, diarrhea, headache, dizziness.
Serious: Gastrointestinal bleeding, perforation, or ulceration; cardiovascular thrombotic events; hypertension; heart failure; renal impairment; hepatotoxicity; severe skin reactions; anaphylactic reactions. Topical: Application site reactions (dryness, irritation, rash).
Drug interaction
Significant interactions with: anticoagulants (increased bleeding risk), ACE inhibitors/ARBs (reduced antihypertensive effect, worsened renal function), diuretics (reduced diuretic efficacy, nephrotoxicity), lithium (increased lithium levels), methotrexate (increased methotrexate toxicity), cyclosporine (increased nephrotoxicity), other NSAIDs (increased adverse effects), SSRIs/SNRIs (increased bleeding risk).
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. For topical formulations, apply the missed dose when remembered and then resume regular schedule.
Overdose
Symptoms may include nausea, vomiting, epigastric pain, gastrointestinal bleeding, drowsiness, dizziness, tinnitus, seizures, respiratory depression, coma, acute renal failure, hepatotoxicity. Management is supportive and symptomatic. Gastric lavage and activated charcoal may be considered if presented early. Hemodialysis is not effective due to high protein binding.
Storage
Store at room temperature (15-30°C/59-86°F) in original container. Protect from moisture and light. Keep all medications out of reach of children. Do not use after expiration date. Do not freeze. For topical formulations, keep tube tightly closed when not in use.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should determine the appropriate dosage and treatment regimen based on individual patient factors. Never share prescription medications with others.
Reviews
“Diclofenac has been instrumental in managing my rheumatoid arthritis symptoms. The 75mg delayed-release formulation provides sustained relief with twice-daily dosing.” - Rheumatology specialist, 15 years experience
“Topical diclofenac gel offers excellent localized pain relief for osteoarthritis patients who cannot tolerate oral NSAIDs due to GI concerns.” - Orthopedic surgeon
“While effective, we must remain vigilant about cardiovascular and renal risks, particularly in elderly patients on long-term therapy.” - Clinical pharmacologist
“The rapid onset of action with diclofenac potassium makes it valuable for acute migraine treatment in selected patients.” - Neurologist
“Injectable diclofenac provides effective postoperative pain control with the advantage of not causing respiratory depression like opioids.” - Anesthesiologist