diclofenac, Voltaren, Cataflam, Voltaren-XR, Cambia
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
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.
Medical and Pharmacy Editor:
GENERIC NAME: diclofenac
BRAND NAMES: Voltaren, Cataflam, Voltaren-XR, Cambia
DRUG CLASS AND MECHANISM: Diclofenac belongs to a class of drugs called nonsteroidal 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.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (delayed release): 25, 50 and 75 mg. Tablets (immediate release): 50 mg. Tablets (extended release): 100 mg. Capsule: 25 mg. Oral Solution: 50 mg
STORAGE: Diclofenac should not be stored above 30 C (86 F) and should be protected from moisture.
PRESCRIBED FOR: Diclofenac is used primarily for the treatment of inflammation and pain caused by conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It also is effective in treating soft tissue inflammation that causes tendinitis and bursitis, and for treating dysmenorrhea (menstrual cramps).
DOSING: Diclofenac should be taken with food to reduce stomach upset. The recommended dose for most conditions is 100-200 mg daily. Dosing intervals are 2 to 4 times daily depending 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, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
Diclofenac increases the effect of cyclosporine on kidney function because both drugs reduce kidney function.
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.
Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking ibuprofen or other NSAIDs.
PREGNANCY: Like other NSAIDs, diclofenac is generally avoided during pregnancy because it may affect the cardiovascular system of the fetus.
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