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: Arthrotec is a combination of diclofenac and
misoprostol. Diclofenac is a
nonsteroidal anti-inflammatory drug (NSAID) similar
to ibuprofen (Motrin or Advil), naproxen (Naprosyn), and others that is used to
treat inflammation, pain, and fever. Diclofenac, like other NSAIDs works by
inhibiting the production of prostaglandins. Prostaglandins are a family of
chemicals produced by the cells of the body that promote inflammation, pain, and
fever. In addition, they support the function of platelets that are necessary
for the clotting of blood, and protect the lining of the stomach from the
damaging effects of acid.
Prostaglandins are produced by the enzyme cyclooxygenase (Cox). There actually are two Cox enzymes, Cox-1 and Cox-2. Both
enzymes produce prostaglandins that promote inflammation, pain, and fever.
However, only Cox-1 produces prostaglandins that support platelets and protect
the stomach. Diclofenac blocks both Cox enzymes and reduces prostaglandins
throughout the body. As a consequence, ongoing inflammation, pain, and fever are
reduced. Since prostaglandins that protect the stomach and support platelets and
blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and
promote bleeding. Misoprostol is a synthetic (man-made) prostaglandin that
stimulates secretion of mucus in the gastrointestinal tract. Mucus protects the
lining of the stomach from acid. Misoprostol has been shown to reduce the
frequency of ulcers of the stomach caused by NSAIDs. Arthrotec was approved by
the FDA in December 1997.
STORAGE: The tablets should be kept at room temperature, 15-30 C
(59-86 F).
PRESCRIBED FOR: Arthrotec is used for treating signs and symptoms of
rheumatoid arthritis or osteoarthritis in patients at risk for developing ulcers
and complications of ulcers due to NSAIDs.
DOSING: For osteoarthritis the recommended dose is Arthrotec 50 given
three times daily. Patients who cannot tolerate this regimen may be treated with
Arthrotec 50 or 75 twice daily. The recommended dose for treating rheumatoid arthritis is Arthrotec 50 given 3-4 times daily. If this regimen is not
tolerated, Arthrotec 50 or 75 twice a day may be used. Administering Arthrotec
twice daily is less effective for preventing ulcers. Taking Arthrotec with food
may reduce stomach upset. It is recommended that Arthrotec not be taken with
alcohol because of the increased risk for ulcers.
DRUG INTERACTIONS: (Please also see the drug information for
diclofenac.) Diclofenac is generally used with caution in patients taking blood
thinning medications (anticoagulants), such as warfarin (Coumadin), because of
the increased risk of bleeding.
Patients taking lithium
(Eskalith,
Lithobid) can develop toxic blood levels of lithium because diclofenac may inhibit the elimination of lithium from the
body by the kidney.
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.
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.
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.
Ankle pain can be caused by injury or disease of the ankle joint.
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 inflammatory arthritis.
How is the ankle designed, and what is the
ankle's
function?
The ankle is
a "hinged" joint capable of moving the foot in two primary directions: away from
the body (plantar flexion) and toward the body (dorsiflexion). It is formed by
the meeting of three bones. The end of the shinbone of the leg (tibia) and a
small bone in the leg (fibula) meet a large bone in the foot, called the talus,
to form the ankle. The end of the shinbone (tibia) forms the inner portion of
the ankle, while the end of the fibula forms the outer portion of the a...
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