Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
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.
BRAND NAME: Dolobid (This brand is no longer available in the U.S.)
DRUG CLASS AND MECHANISM: Diflunisal is a
nonsteroidal antiinflammatory drug
(NSAID) that is effective in treating fever, pain, and inflammation in the body.
Other members of this class include ibuprofen (Motrin), indomethacin (Indocin),
nabumetone (Relafen), naproxen (Anaprox, Naprosyn, Aleve) and several others.
These drugs are used for the management of mild to moderate pain, fever, and
inflammation. They work by reducing the levels of prostaglandins, chemicals that
are responsible for pain, fever, and inflammation. Diflunisal blocks the enzymes
that make prostaglandins (cyclooxygenases), resulting in lower concentrations of
prostaglandins. As a consequence, inflammation, pain and fever are reduced.
Diflunisal was approved by the FDA in April 1982.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 250 and 500 mg.
STORAGE: Diflunisal tablets should be stored in well-sealed containers at a
temperature less than 40 C (104 F), preferably at 15–30 C (59-86 F).
DOSING: For mild to moderate pain, an initial dose of 1000 mg followed by 500
mg every 12 hours is recommended for most patients. For osteoarthritis and
rheumatoid arthritis, the suggested dosage range is 250 mg to 500 mg twice
daily.
DRUG INTERACTIONS: Concomitant use of NSAIDs with
angiotensin-converting
enzyme (ACE) inhibitors such as enalapril (Vasotec) or angiotensin II receptor
antagonists such as irbesartan (Avapro) may reduce the blood pressure response
to the antihypertensive agent since prostaglandins are important in controlling
blood pressure.
Diflunisal 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.
When diflunisal is used in combination with methotrexate
(Rheumatrex, Trexall), the blood levels of
methotrexate may increase, presumably because the elimination from the body is
reduced. This may lead to more methotrexate related side effects.
Individuals taking oral blood thinners or anticoagulants, for example,
warfarin, (Coumadin) should avoid diflunisal because diflunisal also thins the
blood, and excessive blood thinning may lead to bleeding.
PREGNANCY: There are no adequate studies with diflunisal in
pregnant women.
Diflunisal should be used only if the potential benefit justifies the potential
risk.
NURSING MOTHERS: Diflunisal is excreted in
human milk and has a potential for
adverse events to infants.
SIDE EFFECTS: Most patients benefit from diflunisal and other NSAIDs with few
side effects. However, serious side effects can occur and generally tend to be
seen at higher doses. Therefore, it is often desirable to use the lowest
effective dose to minimize side effects. The most common side effects of
diflunisal involve the gastrointestinal system. It can cause ulcerations,
abdominal burning, pain, cramping, nausea, gastritis, and even serious
gastrointestinal bleeding and
liver toxicity. Sometimes, stomach ulceration and
bleeding can occur without any abdominal pain.
Black tarry stools, weakness, and
dizziness upon standing may be the only signs of internal bleeding. Rash, kidney
impairment, ringing in the ears, and lightheadedness also are seen.
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.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
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.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
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.
Osteoarthritis is a joint inflammation that results
from cartilage degeneration.
Osteoarthritis can be caused by aging, heredity, and
injury from trauma or disease.
The most common symptom of osteoarthritis is pain in
the affected joint(s) after repetitive use.
There is no blood test for the diagnosis of
osteoarthritis.
The goal of treatment in osteoarthritis is to reduce joint
pain and inflammation while improving and maintaining joint function.
What is osteoarthritis?
Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting over 25 million people in the United Stat...
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