Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Diclofenac belongs to a class of drugs
called non-steroidal anti-inflammatory drugs (NSAIDs) that are used for the
treatment of mild to moderate pain, fever, and inflammation. Other members of
this class include ibuprofen (Motrin), indomethacin (Indocin), nabumetone
(Relafen), naproxen (Aleve) and several others. NSAIDs work by reducing the
production of prostaglandins, chemicals that cause pain, fever and inflammation.
NSAIDs block the enzyme that makes prostaglandins (cyclooxygenase), resulting in
lower production of prostaglandins. As a consequence, inflammation, pain and
fever are reduced. Since the response to different NSAIDs varies from patient to
patient, it is not unusual for a doctor to try different NSAIDs for any given
condition. The FDA approved diclofenac in July 1998.
DOSING: Diclofenac should be taken with food to reduce stomach upset. The
recommended dose for most conditions is 100-200 mg daily. Dosing intervals
depend on the diclofenac formulation used and the condition being treated.
DRUG INTERACTIONS: Diclofenac, like other NSAIDs is associated with several
suspected or probable interactions that affect the action of other drugs. Some
examples are discussed below.
Diclofenac may increase the blood levels of lithium (Eskalith) by reducing
the excretion of lithium by the kidneys. Increased levels of lithium may lead to
lithium toxicity.
Diclofenac may reduce the blood pressure lowering effects of blood pressure
medications. This may occur because prostaglandins play a role in the regulation
of blood pressure.
When diclofenac is used in combination with aminoglycoside antibiotics [for
example,
gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably
because the elimination of aminoglycosides from the body is reduced. This may
lead to more aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants [for example, warfarin
(Coumadin)]
should avoid diclofenac because diclofenac also thins the blood, and excessive
blood thinning may lead to bleeding.
Combining NSAIDs with methotrexate
(Rheumatrex, Trexall) may reduce the elimination of methotrexate
from the body and result in increased side effects from methotrexate.
PREGNANCY: Like other NSAIDs, diclofenac is generally avoided during
pregnancy because it may affect the cardiovascular system of the fetus.
NURSING MOTHERS: It is not known whether diclofenac is excreted in
breast milk.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Treatment for elbow pain depends upon the nature of the patient's underlying disease or condition.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and antiinflammatory medications and depends on whether there is an infection.
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
Actinic keratoses are rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
The liver, located in the right upper portion of the abdominal cavity just
beneath the right side of the rib cage, has many vital functions. Briefly, some
of these functions are:
Detoxification of blood
Production of important clotting factor and other important proteins
Metabolizing (processing) medications and nutrients
Processing of waste products of hemoglobin
Storing of vitamins, fat, cholesterol, and bile
Production of glucose
What are common liver blood tests?
Liver blood tests are some of the most commonly performed blood tests. These tests can assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes reside within the cells of the liv...
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