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Diclofenac
Systematic (IUPAC) name
2-[2-[(2,6-dichlorophenyl)amino]phenyl]acetic acid
Identifiers
CAS number 15307-86-5
ATC code D11AX18 , M01AB05, M02AA15, S01BC03
PubChem 3033
DrugBank APRD00527
ChemSpider 2925
Chemical data
Formula C14H11Cl2NO2 
Mol. mass 296.148 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 100%
Protein binding more than 99%
Metabolism hepatic, no active metabolites exist
Half life 1.2-2 hr (35% of the drug enters enterohepatic recirculation)
Excretion biliary, only 1% in urine
Therapeutic considerations
Pregnancy cat. A(AU) B (1st. and 2nd. trimenon), X (third trimenon)
Legal status .POM (UK) Rx-only most preparations/countries.^ In the United Kingdom, India, and the United States, it may be supplied as either the sodium or potassium salt, in China most often as the sodium salt, while in some other countries only as the potassium salt.
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.Limited OTC some countries.^ Over the counter (OTC) use is approved in some countries for minor aches and pains and fever associated with common infections.
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^ Diclofenac is also available over the counter (OTC) in some countries: Voltaren® dolo (12.5 mg diclofenac as potassium salt) in Switzerland and Germany, and preparations with 25 mg diclofenac are OTC in New Zealand.
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.Manufacture and veterinary use is banned in India, Nepal and Pakistan due to imminent extinction of local vultures.^ The slender-billed and the long-billed vultures, both only found in northern India, Nepal and Pakistan, have declined by about 97% over the same period.
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^ It is imperative that [diclofenac] is removed completely from use in livestock without any further delay to avoid the extinction of the three vulture species."
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^ Although the drug, diclofenac, has been used in human medicine for decades, it has only recently been introduced for veterinary use in India and Pakistan.
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Routes oral, rectal, im, iv (renal- and gallstones), topical
 Yes check.svgY(what is this?)  (verify)
.Diclofenac (marketed as Voltaren and under a number of other trade names, see below) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation and as an analgesic reducing pain in conditions such as arthritis or acute injury.^ Also offering analgesic anti inflammatory gels and other pharmaceutical formulations.
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^ Prescription: Diclofenac is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs).
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^ USES: This medication is a nonsteroidal anti-inflammatory drug which relieves pain and reduces inflammation (swelling).
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.It can also be used to reduce menstrual pain, dysmenorrhea.^ It is used to reduce swelling and to treat pain.
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^ It can also be used to reduce menstrual pain , dysmenorrhea .
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^ It can also be used to reduce menstrual pain, dysmenorrhea.
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.The name is derived from its chemical name: 2-(2,6-dichloranilino)phenylacetic acid.^ The name is derived from its chemical name: 2-(2,6- dichlo ranilino) phen yl ac etic acid.
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^ The name is derived from its chemical name: 2-(2,6- dichlo ranilino) phen yl ac etic acid In the United Kingdom , India , and the United States , it may be supplied as either the sodium or potassium salt , in China most often as the sodium salt, while in some other countries only as the potassium salt.
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^ Diclofenac - PubChem Public Chemical Database Diclofenac potassium tablets are a benzeneacetic acid derivative.
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.In the United Kingdom, India, and the United States, it may be supplied as either the sodium or potassium salt, in China most often as the sodium salt, while in some other countries only as the potassium salt.^ In the United Kingdom Voltarol can be supplied with either the sodium salt or potassium salt, while Cataflam in some other countries is the potassium salt only.
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^ The name is derived from its chemical name: 2-(2,6- dichlo ranilino) phen yl ac etic acid In the United Kingdom , India , and the United States , it may be supplied as either the sodium or potassium salt , in China most often as the sodium salt, while in some other countries only as the potassium salt.
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^ In the United Kingdom, India, and the United States, it may be supplied as either the sodium or potassium salt, in China most often as the sodium salt, while in some other countries only as the potassium salt.
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.Diclofenac is available as a generic drug in a number of formulations.^ Diclofenac is available as a generic drug in a number of formulations.
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^ (NB. Diclofenac is also available without a brand name, ie as the generic medicine.
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^ The systemic absorption of Voltaren Gel (1 percent diclofenac sodium in topical gel formulation) is 94 percent less than oral diclofenac (generic for Voltaren).
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.Over the counter (OTC) use is approved in some countries for minor aches and pains and fever associated with common infections.^ Over the counter (OTC) use is approved in some countries for minor aches and pains and fever associated with common infections.
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Contents

History

Diclofenac originated from Ciba-Geigy (now Novartis) in 1973.[1] Diclofenac was first introduced in the UK in 1979.[2][3]

Mechanism of action[4]

.The exact mechanism of action is not entirely known, but it is thought that the primary mechanism responsible for its anti-inflammatory, antipyretic, and analgesic action is inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX) and it appears to inhibit DNA synthesis.^ Inhibiting prostaglandin helps decrease the inflammatory response in the eye.
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^ Diclofenac sodium is an analgesic, antipyretic, anti-inflammatory drug ( 9 ) which specifically inhibits prostaglandins.
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^ The exact mechanism of action is not entirely known, but it is thought that the primary mechanism responsible for its anti-inflammatory/antipyretic/analgesic action is inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX).
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[5]
.Inhibition of COX also decreases prostaglandins in the epithelium of the stomach, making it more sensitive to corrosion by gastric acid.^ Inhibition of COX also decreases prostaglandins in the epithelium of the stomach , making it more sensitive to corrosion by gastric acid .
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^ The exact mechanism of action is not entirely known, but it is thought that the primary mechanism responsible for its anti-inflammatory / antipyretic / analgesic action is inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX).
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^ The prostaglandin maintains prostaglandin activity needed to protect the lining of the stomach and reduce acid secretion, reducing the risk of ulcers.
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.This is also the main side effect of diclofenac.^ What side effects are possible with PMS-Diclofenac?
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^ What are the possible side effects of diclofenac?
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^ What are the possible side effects of diclofenac topical?
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.Diclofenac has a low to moderate preference to block the COX2-isoenzyme (approximately 10-fold) and is said to have therefore a somewhat lower incidence of gastrointestinal complaints than noted with indomethacin and aspirin.^ Diclofenac has a low to moderate preference to block the COX2-isoenzyme (approximately 10-fold) and is said to have therefore a somewhat lower incidence of gastrointestinal complaints than noted with indomethacin and aspirin .
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^ Gastrointestinal complaints are most often noted (see above).
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^ Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors.
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[citation needed]
.The action of one single dose is much longer (6 to 8 hours) than the very short half-life that the drug indicates.^ Half-life elimination: 2 hours .
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^ The action of one single dose is much longer (6 to More From Wikipedia » Related in the Kosmos .
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^ Diclofenac is 99.7% protein bound and has a mean terminal elimination half-life of 1-2 hours.
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.This could partly be due to a particular high concentration achieved in synovial fluids.^ This could partly be due to a particular high concentration achieved in synovial fluids .
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.Diclofenac may also be a unique member of the NSAIDs.^ Diclofenac may also be a unique member of the NSAIDs .
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^ A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006 found no additional cardiovascular risk from Diclofenac use.
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^ These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a broad basis.
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.There is some evidence that diclofenac inhibits the lipoxygenase pathways,[citation needed] thus reducing formation of the leukotrienes (also pro-inflammatory autacoids).^ There is some evidence that diclofenac inhibits the lipoxygenase pathways, thus reducing formation of the leukotrienes (also pro-inflammatory autacoids).
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^ Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which result in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties .
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^ Voltarol e/c tablets have a special 'enteric coating' that is designed to prevent the absorption of the diclofenac in the stomach, and thus reduce the risk of stomach irritation and indigestion.
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.There is also speculation that diclofenac may inhibit phospholipase A2 as part of its mechanism of action.^ There is also speculation that diclofenac may inhibit phospholipase A 2 as part of its mechanism of action.
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^ These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a broad basis.
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^ Diclofenac may impair the ability of the kidney to cope with low renal blood flow states due to inhibition of prostaglandin-dependent afferent arteriolar vasodilation.
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.March 2009" style="white-space:nowrap;">[citation needed] These additional actions may explain the high potency of diclofenac – it is the most potent NSAID on a broad basis.^ These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a broad basis.
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^ Diclofenac may also be a unique member of the NSAIDs .
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^ A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006 found no additional cardiovascular risk from Diclofenac use.
  • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

[citation needed]
.There are marked differences among NSAIDs in their selective inhibition of the two subtypes of cyclo-oxygenase, COX-1 and COX-2. Much pharmaceutical drug design has attempted to focus on selective COX-2 inhibition as a way to minimize the gastrointestinal side effects of NSAIDs like aspirin.^ There were minimal side effects with both the drugs.
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^ Side effects like pain on Inj.
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^ There are marked differences among NSAIDs in their selective inhibition of the two subtypes of cyclo-oxygenase, COX-1 and COX-2.
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.In practice, use of some COX-2 inhibitors due to their adverse effects has led to massive numbers of patient family lawsuits alleging wrongful death by heart attack, yet other significantly COX-selective NSAIDs like diclofenac have been well-tolerated by most of the population.^ Do not use Voltaren Emulgel if you are allergic to Diclofenac or other NSAIDs.
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^ In practice, use of some COX-2 inhibitors due to their adverse effects has led to massive numbers of patient family lawsuits alleging wrongful death by heart attack , yet other significantly COX-selective NSAIDs like diclofenac have been well-tolerated by most of the population.
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^ COX-2 inhibitors are a subset of NSAIDs.
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.Besides the well-known and often cited COX-inhibition, a number of other molecular targets of diclofenac have recently been identified which could contribute to its pain-relieving actions.^ Voltaren reduces pain, swelling, and inflammation, and often used to relieve pain for people with rheumatoid arthritis, osteoarthritis, and degenerative joint diseases.
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^ As a group, NSAIDs are non-narcotic relievers of mild to moderate pain of many causes, including injury, menstrual cramps, arthritis, and other musculoskeletal conditions.
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^ Surveys of veterinarians and pharmacists identified diclofenac as a recently introduced and widely used non-steroidal anti-inflammatory drug (NSAID), known to be toxic to the kidneys of mammals.
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These include:
  • Blockade of voltage-dependent sodium channels (after activation of the channel, diclofenac inhibits its reactivation also known as phase inhibition)[citation needed]
  • Blockade of acid-sensing ion channels (ASICs)[citation needed]
  • Positive allosteric modulation of KCNQ- and BK-potassium channels (diclofenac opens these channels, leading to hyperpolarization of the cell membrane)[citation needed]

Indications

Voltaren enteric coated tablets (AU)
Combined Diclofenac sodium and misoprostol tablets
A vial of Diclofenac sodium intended for IV/IM use
.Diclofenac is used for musculoskeletal complaints, especially arthritis, rheumatoid arthritis, Polymyositis, Dermatomyositis, osteoarthritis,dental pain, TMJ, spondylarthritis, ankylosing spondylitis, gout attacks, and pain management in cases of kidney stones and gallstones.^ Diclofenac is used to treat pain or inflammation caused by arthritis or ankylosing spondylitis.
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^ Diclofenac is used for the treatment of inflammation and pain caused by arthritis conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.
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^ The prescription pain reliever diclofenac can also be used to treat arthritis and migraines.
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.An additional indication is the treatment of acute migraines.^ An additional indication is the treatment of acute migraines.
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.Diclofenac is used commonly to treat mild to moderate post-operative or post-traumatic pain, particularly when inflammation is also present, and is effective against menstrual pain and endometriosis.^ Aleve Aleve (Naproxen) is used for the treatment of mild to moderate pain, inflammation and fever.
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^ It is also used in the management of mild to moderate pain such as primary dysmenorrhea.
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^ Keywords: post-operative pain .
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Diclofenac suppositories
.As long-term use of diclofenac and similar NSAIDs predisposes for peptic ulcer, many patients at risk for this complication are prescribed a combination (Arthrotec) of diclofenac and misoprostol, a synthetic prostaglandin analogue, to protect the gastric mucosa.^ ARTHROTEC (diclofenac contains diclofenac, one of the most frequently prescribed NSAIDs, plus misoprostol, a .
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^ Description: Arthrotec is a combination of diclofenac .
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^ DICLOFENAC; MISOPROSTOL (Arthrotec) is a combination of two drugs.
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.An external, gel-based formulation containing 3% of diclofenac (Solaraze) is available for the treatment of facial actinic keratosis which is caused by over-exposure to sunlight.^ Based on clinical trial data and postmarketing experiences, transaminases should be monitored within 4 to 8 weeks after initiating treatment with diclofenac.
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^ A: The FDA recently announced that treatment with all products containing diclofenac sodium might increase liver dysfunction, resulting in severe liver reactions and liver transplantation or death.
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^ The systemic absorption of Voltaren Gel (1 percent diclofenac sodium in topical gel formulation) is 94 percent less than oral diclofenac (generic for Voltaren).
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.Some countries have also approved the external use of diclofenac 1% gel to treat musculoskeletal conditions.^ Diclofenac Gel Diclofenac Gel is an NSAID, used to treat the symptoms of pain and inflammation.
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^ Some countries have also approved the external use of diclofenac 1% gel to treat musculoskeletal conditions.
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^ Over the counter (OTC) use is approved in some countries for minor aches and pains and fever associated with common infections.
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.In many countries eye-drops are sold to treat acute and chronic non-bacterial inflammations of the anterior part of the eyes (e.g.^ Eye drops: For inflammation, it is recommended that one drop be put into the eye 4 to 5 times daily.
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^ The eye drop is used to reduce eye inflammation before and after eye surgery (e.g., cataract surgery) and in other cases of eye inflammation where infection is not present.
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postoperative states). .A common brand name is Voltaren-ophta.^ A common brand name is Voltaren-ophta.
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^ Brand name: Voltaren Generic name: Diclofenac .
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^ Brand names: Cataflam, Voltaren Voltaren and Cataflam are nonsteroidal anti-inflammatory drugs used to relieve the inflammation, swelling, stiffness, and joint pain associated with rheumatoid arthritis, osteoarthritis (the most common form of arthritis), and ankylosing spondylitis (arthritis and stiffness of the spine).
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Off label/investigational uses

.Diclofenac is often used to treat chronic pain associated with cancer, particularly if inflammation is also present (Step I of the World Health Organization (WHO) Scheme for treatment of chronic pain).^ Diclofenac is often used to treat chronic pain associated with cancer , particularly if inflammation is also present (Step I of the World Health Organisation (WHO) Scheme for treatment of chronic pain).
  • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

^ Diclofenac Gel Diclofenac Gel is an NSAID, used to treat the symptoms of pain and inflammation.
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^ Diclofenac is used to treat pain or inflammation caused by arthritis or ankylosing spondylitis.
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.Good results (sometimes better than those with opioids) have been seen in female breast cancer and in the pain associated with bony metastases.^ Elevations in transaminases were seen more frequently in patients with osteoarthritis than in those with rheumatoid arthritis.
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^ Murphy DF. NSAIDs and postoperative pain: sooner is better than later.
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^ However, if you have sudden severe pain and desire quick relief, it may be better to use other pain medications that are faster acting than this medication.
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Diclofenac can be combined with opioids if needed. .Combaren, a fixed combination of diclofenac and codeine (50 mg each), is available for cancer treatment in Europe.^ Diclofenac Potassium 50 mg-TEV .
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^ Diclofenac 50 mg-GG .
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^ Diclofenac Sodium 50 mg-ROX .
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.Combinations with psychoactive drugs such as chlorprothixene and/or amitriptyline have also been investigated and found useful in a number of cancer patients.^ Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).
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^ The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient.
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^ The 2002 ACCM/SCCM guidelines for analgesia (critically-ill adult) suggest that NSAIDs may be used in combination with opioids in select patients for pain management.
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Fever due to malignant lymphogranulomatosis (Hodgkin's lymphoma) often responds to diclofenac. .Treatment can be terminated as soon as the usual treatment with radiation and/or chemotherapy causes remission of fever.^ Treatment can be terminated as soon as the usual treatment with radiation and/or chemotherapy causes remission of fever.
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.Diclofenac may prevent the development of Alzheimer's disease if given daily in small doses during many years.^ Diclofenac may prevent the development of Alzheimer's disease if given daily in small doses during many years.
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^ Hepatic Insufficiency Hepatic metabolism accounts for almost 100% of diclofenac sodium elimination, so patients with hepatic disease may require reduced doses of D...
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^ As this eMedTV segment explains, the recommended dose of oral diclofenac for pain relief is 50 mg three times daily or 25 mg four times a day.
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.All investigations were stopped after it was found that some of the other investigated NSAIDs (naproxen, rofecoxib) caused a higher incidence of death cases due to cardiovascular events and stroke compared to placebo.^ All investigations were stopped after it was found that some of the other investigated NSAIDs (naproxen, rofecoxib) caused a higher incidence of death cases due to cardiovascular events and stroke compared to placebo.
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^ In practice, use of some COX-2 inhibitors due to their adverse effects has led to massive numbers of patient family lawsuits alleging wrongful death by heart attack , yet other significantly COX-selective NSAIDs like diclofenac have been well-tolerated by most of the population.
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^ Following the identification of increased risks of heart attacks with the selective COX-2 inhibitor rofecoxib in 2004, attention has focused on all the other members of the NSAIDs group, including Diclofenac.
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.Diclofenac has been found to increase the blood pressure in patients with Shy-Drager syndrome and Diabetes Mellitus.^ And that various studies found that diclofenac increase these dangers the most compared with other pills, even at doses less ...
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^ Ciclosporin may increase the blood level of diclofenac, and your doctor may prescribe a lower than normal dose of diclofenac if you are taking ciclosporin.
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^ Diclofenac may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines.
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.Currently, this use is highly investigative and cannot be recommended as routine treatment.^ Currently, this use is highly investigational and cannot be recommended as routine treatment.
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^ Immediate-release tablets: Acute treatment of mild to moderate pain Use - Unlabeled/Investigational: .
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^ Immediate-release tablets: Acute treatment of mild to moderate pain Use - Unlabeled/Investigational .
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.Diclofenac has been found to be effective against all strains of multi drug resistant E. coli, with a MIC of 25 micrograms/mL. Therefore, it may be suggested that diclofenac has the capacity to treat uncomplicated urinary tract infections (UTI) caused by E. coli.^ Diclofenac has been found to be effective against all strains of multi drug resistant E. coli, with a MIC of 25 microg/mL. Therefore, it may be suggested that diclofenac has the capacity to treat UTI (uncomplicated urinary tract infections) caused by E. coli .
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^ A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006 found no additional cardiovascular risk from Diclofenac use.
  • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

^ Diclofenac is used commonly to treat mild to moderate post-operative or post-traumatic pain, particularly when inflammation is also present, and is effective against menstrual pain.
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[6] .It has also been shown to be effective in treating Salmonella infections in mice[7] and is under investigation for the treatment of tuberculosis.^ It has also been shown to be effective in treating Salmonella infections in mice and is under investigation for the treatment of tuberculosis.
  • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

[8]
Diclofenac is an antiuricosuric.[9]

Contraindications

  • Hypersensitivity against diclofenac
  • History of allergic reactions (bronchospasm, shock, rhinitis, urticaria) following the use of Aspirin or another NSAID
  • Third-trimester pregnancy
  • Active stomach and/or duodenal ulceration or gastrointestinal bleeding
  • Inflammative intestinal disorders such as Crohn's disease or ulcerative colitis
  • Severe insufficiency of the heart (NYHA III/IV)
  • Recently, a warning has been issued by FDA not to use to treat patients recovering from heart surgery
  • Severe liver insufficiency (Child-Pugh Class C)
  • Severe renal insufficiency (creatinine clearance <30 ml/min)
  • Caution in patients with preexisting hepatic porphyria, as diclofenac may trigger attacks
  • Caution in patients with severe, active bleeding such as cerebral hemorrhage
  • NSAIDs in general should be avoided during dengue fever.

Side effects

.
  • Diclofenac is among the better tolerated NSAIDs.^ Diclofenac is among the better tolerated NSAIDs.
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    Though 20% of patients on long-term treatment experience side effects, only 2% have to discontinue the drug, mostly due to gastrointestinal complaints.

Cardiac

.
  • Following the identification of increased risks of heart attacks with the selective COX-2 inhibitor rofecoxib in 2004, attention has focused on all the other members of the NSAIDs group, including diclofenac.^ Following the identification of increased risks of heart attacks with the selective COX-2 inhibitor rofecoxib in 2004, attention has focused on all the other members of the NSAIDs group, including Diclofenac.
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    ^ Aspirin is an NSAID medicine but it does not increase the chance of a heart attack.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ All NSAIDs, both COX-2 selective and nonselective, may have a similar risk.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    .Research results are mixed with a meta-analysis of papers and reports up to April 2006 suggesting a relative increased rate of heart disease of 1.63 compared to non users.^ Heart rate suppression has been reported.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    ^ Research results are mixed with a meta-analysis of papers and reports up to April 2006 suggesting a relative increased rate of heart disease of 1.63 compared to non users.
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    ^ The risk of these serious side effects may increase if you have heart disease and with longer use of this medication.
    • Diclofenac Sodium Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: General]

    [10] .Professor Peter Weissberg, Medical Director of the British Heart Foundation said, "However, the increased risk is small and many patients with chronic debilitating pain may well feel that this small risk is worth taking to relieve their symptoms". Only Aspirin was found not to increase the risk of heart disease; however, this is known to have a higher rate of gastric ulceration than diclofenac.^ Professor Peter Weissberg, Medical Director of the British Heart Foundation said, "However, the increased risk is small and many patients with chronic debilitating pain may well feel that this small risk is worth taking to relieve their symptoms".
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    ^ This risk may increase with duration of use.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
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    .A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006, found no additional cardiovascular risk from diclofenac use.^ This risk may increase with duration of use.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006 found no additional cardiovascular risk from Diclofenac use.
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    ^ Diclofenac may also be a unique member of the NSAIDs .
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    [11]
  • .
  • Diclofenac has similar COX-2 selectivity to celecoxib.^ Diclofenac has similar COX-2 selectivity to celecoxib .
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    ^ All NSAIDs, both COX-2 selective and nonselective, may have a similar risk.
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    ^ Selective inhibitors of COX-2 such as celecoxib or etoricoxib should also be avoided for the same reason.
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    [12] .Perhaps related to this selectivity, a review of this constantly changing topic by FDA Medical Officer David Graham concluded in September, 2006 that diclofenac does increase the risk of myocardial infarction.^ Perhaps related to this selectivity, a review of this constantly changing topic by FDA Medical Officer David Graham concluded in September, 2006 that Diclofenac does increase the risk of myocardial infarction .
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    ^ A subsequent large study of 74,838 users of NSAIDs or coxibs, published in May 2006 found no additional cardiovascular risk from Diclofenac use.
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    ^ Following the identification of increased risks of heart attacks with the selective COX-2 inhibitor rofecoxib in 2004, attention has focused on all the other members of the NSAIDs group, including Diclofenac.
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    [13]

Gastrointestinal

.
  • Gastrointestinal complaints are most often noted (see above).^ Gastrointestinal complaints are most often noted (see above).
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    .The development of ulceration and/or bleeding requires immediate termination of treatment with diclofenac.^ There may be an increased risk of ulceration or bleeding from the gut if diclofenac is taken with corticosteroids such as prednisolone.
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    ^ During the field study, one diclofenac-treated horse developed colic on day four of the study and responded to symptomatic treatment.
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    ^ One diclofenac-treated horse developed colic and responded to symptomatic treatment on day four of the study.
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    Most patients receive an ulcer-protective drug as prophylaxis during long-term treatment (misoprostol, ranitidine 150 mg at bedtime or omeprazole 20 mg at bedtime).

Hepatic

.
  • Liver damage occurs infrequently, and is usually reversible.^ Liver damage occurs infrequently, and is usually reversible.
    • Diclofenac encyclopedia topics | Reference.com 19 January 2010 18:018 UTC www.reference.com [Source type: Academic]

    .Hepatitis may occur rarely without any warning symptoms and may be fatal.^ Gastrointestinal bleeding may occur without prior symptoms of gastrointestinal irritation.
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    ^ These serious events may occur without warning.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ This eMedTV article takes a closer look at these and other signs and symptoms that may occur in someone with diverticulitis.
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    .Patients with osteoarthritis more often develop symptomatic liver disease than patients with rheumatoid arthritis.^ Elevations in transaminases were seen more frequently in patients with osteoarthritis than in those with rheumatoid arthritis.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ Unlike aspirin-related elevations, which occur more frequently in patients with rheumatoid arthritis, these elevations were more frequently observed in patients with osteoarthritis (2.6%) than in patients with rheumatoid arthritis (0.7%).
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    ^ Treatment of signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis (RA) in patients at high risk of developing NSAID-induced gastric...
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    .Liver function should be monitored regularly during long-term treatment.^ Laboratory and/or medical tests (e.g., kidney function, potassium blood level) should be performed periodically to monitor your progress or check for side effects.
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    ^ In patients on long-term treatment with NSAIDs, including Voltaren, the CBC and a chemistry profile (including transaminase levels) should be checked periodically.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    .If used for the short term treatment of pain or fever, diclofenac has not been found to be more hepatotoxic than other NSAIDs.
  • As of 12/2009 Endo, Novartis and FDA notified healthcare professionals to add new warnings and precautions about the potential for elevation in liver function tests during treatment with all products containing diclofenac sodium.^ Other forms of Diclofenac Sodium Oral .
    • Diclofenac Sodium Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: General]

    ^ Diclofenac Gel Diclofenac Gel is an NSAID, used to treat the symptoms of pain and inflammation.
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    ^ For the treatment of pain, diclofenac is often prescribed by healthcare providers.
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    [14]
  • .
  • Cases of drug-induced hepatotoxicity have been reported in the first month, but can occur at any time during treatment with diclofenac.^ In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of therapy, but can occur at any time during treatment with diclofenac.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ This side effect can occur without warning at any time during treatment with diclofenac.
    • Diclofenac Sodium Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: General]

    ^ However, severe hepatic reactions can occur at any time during treatment with diclofenac.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    .Postmarketing surveillance has reported cases of severe hepatic reactions, including liver necrosis, jaundice, fulminant hepatitis with and without jaundice, and liver failure.^ Rare cases of severe hepatic reactions (including necrosis, jaundice, fulminant hepatitis) have been reported.
    • Diclofenac 19 January 2010 18:018 UTC www.umm.edu [Source type: Academic]
    • Diclofenac - Alternative Medicine Report 19 January 2010 18:018 UTC www.qualityhealth.com [Source type: Academic]

    ^ In addition, rare cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and hepatic failure, some of them with fatal outcomes have been reported.
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    ^ Fatal cases of fulminant hepatitis have been reported in the literature.
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    .Some of these reported cases resulted in fatalities or liver transplantation.
  • Physicians should measure transaminases periodically in patients receiving long-term therapy with diclofenac.^ Diclofenac-induced hepatitis may be a result of a hypersensitivity in some cases.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    ^ Physicians should measure transaminases periodically in patients receiving long-term therapy with diclofenac, because severe hepatotoxicity may develop without a prodrome of distinguishing symptoms.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia.
    • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

    Based on clinical trial data and postmarketing experiences, transaminases should be monitored within 4 to 8 weeks after initiating treatment with diclofenac.

Renal

.
  • Studies in Pakistan showed that diclofenac caused acute kidney failure in vultures when they ate the carcasses of animals that had recently been treated with it (see below at Ecological problems).^ The diclofenac patch is a prescription pain medicine used to treat acute pain caused by sprains and strains.
    • Diagnosing Hemorrhoids - Diclofenac Sodium Side Effects Articles 15 September 2009 7:45 UTC www.emedtv.com [Source type: Academic]

    ^ One diclofenac-treated horse developed colic and responded to symptomatic treatment on day four of the study.
    • Medi-Vet - Surpass (1% diclofenac sodium) Topical Anti-Inflammatory Cream 19 January 2010 18:018 UTC www.medi-vet.com [Source type: Academic]

    ^ Kaposi's sarcoma Keloid Kidney failure - acute Kidney failure - end-stage Kidney transplantation Kwashiorkor Kawasaki disease Kidney dialysis Kidney failure - chronic Kidney stones Klinefelter's syndrome .
    • Health24 - Medical 19 January 2010 18:018 UTC www.health24.com [Source type: FILTERED WITH BAYES]

    .Species and individual humans that are drug sensitive are initially assumed to lack genes expressing specific drug detoxification enzymes.
  • NSAIDs "are associated with adverse renal [kidney] effects caused by the reduction in synthesis of renal prostaglandins"[15] in sensitive persons or animal species, and potentially during long term use in non-sensitive persons if resistance to side effects decreases with age.^ Long-term NSAID use may result in renal papillary necrosis.
    • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

    ^ Arthrotec is a nonsteroidal drug (NSAID) used in .
    • ARTHROTEC(diclofenac sodiummisoprostol) tablets 15 September 2009 7:45 UTC indianrapunzels.com [Source type: FILTERED WITH BAYES]

    ^ Renal impairment: NSAID use may compromise existing renal function; dose-dependent decreases in prostaglandin synthesis may result from NSAID use, reducing renal blood flow which may cause renal decompensation.
    • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

    .Unfortunately this side effect can't be avoided merely by using a COX-2 selective inhibitor because, "Both isoforms of COX, COX-1 and COX-2, are expressed in the kidney...^ The most common side effects, despite the use of an enteric coated formulation, have included gastric upset or discomfort.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    ^ The risk of these serious side effects may increase if you have heart disease and with longer use of this medication.
    • Diclofenac Sodium Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: General]

    ^ Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Diclofenac Drops: .
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    .Consequently, the same precautions regarding renal risk that are followed for nonselective NSAIDs should be used when selective COX-2 inhibitors are administered."^ NSAID medicines should only be used: .
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ All NSAIDs, both COX-2 selective and nonselective, may have a similar risk.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    ^ Caution should be used when NSAIDs are administered concomitantly with methotrexate.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]
    • Voltaren Tablets (Novartis), Drug Reference Encyclopedia 18 September 2009 9:58 UTC www.theodora.com [Source type: Academic]

    [15] .However, diclofenac appears to have a different mechanism of renal toxicity.^ No differences in the pharmacokinetics of diclofenac have been detected in studies of patients with renal impairment.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]
    • Voltaren Tablets (Novartis), Drug Reference Encyclopedia 18 September 2009 9:58 UTC www.theodora.com [Source type: Academic]

    ^ In one case, diclofenac-induced thrombocytopenic purpura was accompanied by renal and hepatic toxicity.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    [9]

Other

.
  • Bone marrow depression is noted infrequently (leukopenia, agranulocytosis, thrombopenia with/without purpura, aplastic anemia).^ Hematologic side effects have included anemia, leukopenia, thrombocytopenia, hemolytic anemia, spontaneous bruising associated with increased bleeding times, purpura, agranulocytosis, and aplastic anemia.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    ^ Hemic and Lymphatic: Hemoglobin decrease, leukopenia, thrombocytopenia, hemolytic anemia, aplastic anemia, agranulocytosis, purpura, allergic purpura.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    ^ Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy.
    • Diclofenac 19 January 2010 18:018 UTC www.umm.edu [Source type: Academic]
    • Diclofenac - Alternative Medicine Report 19 January 2010 18:018 UTC www.qualityhealth.com [Source type: Academic]

    .These conditions may be life-threatening and/or irreversible, if detected too late.^ If you have any of these conditions, you may need a dose adjustment or special tests to safely take diclofenac.
    • Buy generic Voltaren (Diclofenac) online | Pain Medicine | Cheap Voltaren 18 September 2009 9:58 UTC www.bellspharmacy.com [Source type: FILTERED WITH BAYES]

    ^ The pharmacological activity of Voltaren in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, painful conditions.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]
    • Voltaren Tablets (Novartis), Drug Reference Encyclopedia 18 September 2009 9:58 UTC www.theodora.com [Source type: Academic]

    .All patients should be monitored closely.^ All affected patients (even when no active disease is present) should wear a Medical Alert bracelet or necklace.
    • Health24 - Medical - Head 2 Toe 19 January 2010 18:018 UTC www.health24.com [Source type: Academic]

    ^ When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short.
    • Diclofenac 19 January 2010 18:018 UTC www.umm.edu [Source type: Academic]
    • Diclofenac - Peoples Rx - Austin's Favorite Pharmacy 19 January 2010 18:018 UTC www.peoplesrx.com [Source type: Academic]
    • Diclofenac - Alternative Medicine Report 19 January 2010 18:018 UTC www.qualityhealth.com [Source type: Academic]
    • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

    ^ During concomitant therapy with NSAIDs, the patient should be observed closely for signs of renal failure (see WARNINGS, Renal Effects), as well as to assure diuretic efficacy.
    • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

    .Diclofenac is a weak and reversible inhibitor of thrombocytic aggregation needed for normal coagulation.
  • Induces warm antibody hemolytic anemia by inducing antibodies to Rh antigens, Ibuprofen also does this.^ Autoimmune hemolytic anemia and thrombocytopenia have been associated with the development of autoantibodies as well as drug- or metabolite-dependent antibodies, implicating a drug hypersensitivity.
    • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

    [16]
  • Diclofenac may disrupt the normal menstrual cycle.

Ecological problems

.Use of diclofenac in animals has been reported to have led to a sharp decline in the vulture population in the Indian subcontinent, 95% decline in 2004, 99.9% decline as of 2008.[17] The mechanism is probably renal failure, a known side-effect of diclofenac.^ A disproportionate amount of postoperative hemorrhage requiring operative intervention has been reported with the use of diclofenac when used for analgesia after adenotonsillectomy.
  • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

^ SURPASS topical cream is contraindicated in animals with known hypersensitivity to diclofenac.
  • Medi-Vet - Surpass (1% diclofenac sodium) Topical Anti-Inflammatory Cream 19 January 2010 18:018 UTC www.medi-vet.com [Source type: Academic]

^ The most common side effects, despite the use of an enteric coated formulation, have included gastric upset or discomfort.
  • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

.Vultures eat the carcasses of livestock that have been administered veterinary diclofenac, and are poisoned by the accumulated chemical.^ Slender-billed vultures have declined dramatically in South Asia since the 1990s as farmers increased their use of a livestock drug that leaves toxic residues in carcasses.
  • Diclofenac (generic), Voltaren, Cataflam News - Topix 19 January 2010 18:018 UTC www.topix.net [Source type: General]

At a meeting of the National Wildlife Board in March 2005, the Government of India announced that it intended to phase out the veterinary use of diclofenac.[18] Meloxicam is a safer candidate to replace use of diclofenac.[19] .It is more expensive than diclofenac, but the price is coming down as more drug companies begin to manufacture it.^ Diclofenac is more than 99% bound to human serum proteins, primarily to albumin.
  • Voltaren Tablets (Novartis), Drug Reference Encyclopedia 18 September 2009 9:58 UTC www.theodora.com [Source type: Academic]

^ This eMedTV page describes diclofenac products in more detail and lists potential side effects of this drug.
  • Diagnosing Hemorrhoids - Diclofenac Sodium Side Effects Articles 15 September 2009 7:45 UTC www.emedtv.com [Source type: Academic]

^ The diclofenac solution is rapidly absorbed from the gut, so this type of Voltarol tablet provides pain relief more quickly than the other types of tablet.
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]
  • Voltarol tablets (diclofenac) 15 September 2009 7:45 UTC www.tiscali.co.uk [Source type: FILTERED WITH BAYES]

[20]
."The loss of tens of millions of vultures over the last decade has had major ecological consequences across the Indian subcontinent that pose a potential threat to human health.^ I think the deterioration of the populations health in the last decade since gm has been introduced should be an indicator.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

In many places, populations of feral dogs (Canis familiaris) have increased sharply from the disappearance of Gyps vultures as the main scavenger of wild and domestic ungulate carcasses. .Associated with the rise in dog numbers is an increased risk of rabies"[19] and casualties of almost 50,000 people.^ Heart Failure: The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema.
  • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

^ Studies have suggested that use of diclofenac may be associated with a small increase in the risk of heart attacks and stroke.
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]

^ There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use.
  • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

[21] .The Government of India cites one of those major consequences as a vulture species extinction.^ One of the major articles discusses how human pathogens make themselves at home on plants, crossing the so-called species barrier.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

[18] .A major shift in transfer of corpse pathogens from vultures to feral dogs and rats can lead to a disease pandemic causing millions of deaths in a crowded country like India.^ Voltaren, like other NSAIDs, may cause serious CV side effects, such as MI or stroke, which may result in hospitalization and even death.
  • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

.The loss of vultures has had a social impact on the Indian Zoroastrian Parsi community, who traditionally use vultures to dispose of human corpses in Towers of Silence, but are now compelled to seek alternate methods of disposal.^ The heros of our day will be those men and women who stepped up and voiced their and their childrens' refusal to be used as human guinea pigs.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

[19]
.Diclofenac has been shown also to harm freshwater fish species such as rainbow trout.^ Indigestion remedies such as antacids should not be taken at the same time as enteric-coated diclofenac tablets, as they will stop the special coating from working.
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]

[22][23][24][25]

Formulations

Enteric Coated Diclofenac Sodium tablets by Dexcel-Pharma Ltd.
.Flector Patch is a minimally systemic topical patch formulation of diclofenac.^ Net sales of FLECTOR ® PATCH (diclofenac epolamine topical patch) 1.3% totaled $40 million during the third quarter of 2009.
  • King Pharmaceuticals Reports Strong Third Quarter 2009 Financial Results: Business Wire Business News: US:KG - MSN Money 19 January 2010 18:018 UTC news.moneycentral.msn.com [Source type: FILTERED WITH BAYES]

.It is indicated for acute pain due to minor sprains, strains, and contusions.^ Topical patch: Acute pain due to minor strains, sprains, and contusions .
  • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

^ The diclofenac patch is a prescription pain medicine used to treat acute pain caused by sprains and strains.
  • Diagnosing Hemorrhoids - Diclofenac Sodium Side Effects Articles 15 September 2009 7:45 UTC www.emedtv.com [Source type: Academic]

^ Painful conditions due to accidents, such as sprains , strains, dislocations, fractures.
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]

.The patch has been approved in many other countries outside the U.S.A under different brand names.^ Diclofenac (marketed as Voltaren and under a number of other trade names, see below) is a non-steroidal anti-inflammatory drug...
  • Diclofenac, Diclofenac Manufacturers & Suppliers 15 September 2009 7:45 UTC www.alibaba.com [Source type: General]

^ The FDA approved Vioxx and other drugs that have killed many thousands of people taking them just as the doctor ordered.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

.Voltaren and Voltarol contain the sodium salt of diclofenac.^ Voltaren ® (diclofenac sodium enteric-coated tablets), is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models.
  • Voltaren Tablets (Novartis), Drug Reference Encyclopedia 18 September 2009 9:58 UTC www.theodora.com [Source type: Academic]

^ Voltaren diclofenac sodium tablet, delayed release .
  • Voltaren Official FDA information, side effects and uses. 18 September 2009 9:58 UTC www.drugs.com [Source type: Academic]

^ Onset of action: Cataflam® is more rapid than sodium salt (Voltaren®) because it dissolves in the stomach instead of the duodenum .
  • Diclofenac 19 January 2010 18:018 UTC www.umm.edu [Source type: Academic]
  • Diclofenac - Alternative Medicine Report 19 January 2010 18:018 UTC www.qualityhealth.com [Source type: Academic]
  • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

.In the United Kingdom Voltarol can be supplied with either the sodium salt or potassium salt, while Cataflam in some other countries is the potassium salt only.^ Only recently did some countries decide to force food manufacturers to properly label trans fats content of foods.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

^ Onset of action: Cataflam® is more rapid than sodium salt (Voltaren®) because it dissolves in the stomach instead of the duodenum .
  • Diclofenac 19 January 2010 18:018 UTC www.umm.edu [Source type: Academic]
  • Diclofenac - Alternative Medicine Report 19 January 2010 18:018 UTC www.qualityhealth.com [Source type: Academic]
  • Diclofenac: Drug Information Provided by Lexi-Comp: Merck Manual Professional 15 September 2009 7:45 UTC www.merck.com [Source type: Academic]

^ Some groups are trying to improve tolerance of crops to salt, heat or cold, or make their growth and maturation go faster by importing genes from other food crops.
  • Blog. Genetically Modified Foods Debate 19 January 2010 18:018 UTC www.genengnews.com [Source type: FILTERED WITH BAYES]

.Diclofenac is available in stomach acid resistant formulations (25 and 50 mg), fast disintegrating oral formulations (25 and 50 mg), slow- and controlled-release forms (75, 100 or 150 mg), suppositories (50 and 100 mg), and injectable forms (50 and 75 mg).^ Diclofenac 75 mg .
  • Diagnosing Hemorrhoids - Diclofenac Sodium Side Effects Articles 15 September 2009 7:45 UTC www.emedtv.com [Source type: Academic]

^ Diclofenac 100 mg .
  • Diagnosing Hemorrhoids - Diclofenac Sodium Side Effects Articles 15 September 2009 7:45 UTC www.emedtv.com [Source type: Academic]

^ Aseptic meningitis was reported in a 42-year-old female following two weeks of therapy with diclofenac 50 mg three times a day.
  • Diclofenac Side Effects | Drugs.com 19 January 2010 18:018 UTC www.drugs.com [Source type: FILTERED WITH BAYES]

.Diclofenac is also available over the counter (OTC) in some countries: 12.5 mg diclofenac as potassium salt in Switzerland, Germany ("Voltaren dolo"), United Kingdom (since October 2008 as "Voltarol Pain-eze"), and preparations containing 25 mg diclofenac as the potassium salt in New Zealand, Australia, Japan, (Voltaren Rapid, and Sweden (Voltaren T and Diclofenac T).^ Voltarol pain-eze emulgel .
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]

^ Voltarol pain-eze tablets .
  • Voltarol tablets (diclofenac) 19 January 2010 18:018 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]

^ I received no relief from ibuprofen, but within two days of starting the diclofenac/voltaren I was no longer in pain.
  • Plse help me find the english name for a muscle relaxer from France | Europe Forum | Fodor's Travel Talk Forums 19 January 2010 18:018 UTC www.fodors.com [Source type: FILTERED WITH BAYES]

Trade names

Trade names include:
  • anuva
  • Abitren
  • Arthrotec (combination with misoprostol)
  • Betaren
  • Cataflam
  • Clofast
  • Dedolor
  • Deflamat
  • Deflox
  • Diclac
  • Diclofenacum
  • Dicloflex
  • Diclogem
  • Diclohexal
  • Diclomax
  • Diclon
  • Diclopar (Tanzania)
  • Difen
  • Difene
  • Dyloject
  • Feloran
  • Flector patch
  • Modifenac
  • Morbidic (India)
  • Motifene
  • Naklofen
  • Olfen
  • Panamor
  • Pennsaid
  • Rhumalgan
  • Sandoz
  • Solaraze
  • Topac
  • Uno
  • Vetagesic
  • Voltaren
  • Voltarol
  • Voltfast
  • Votral (Pakistan)
  • Votrex
  • Vostar
  • Votalin (China)
  • Voveran
  • Zipsor
  • Zolterol

References

  1. ^ http://www.novartis.com/about-novartis/company-history/index.shtml
  2. ^ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1434053
  3. ^ Salmann, AR (1986) The history of diclofenac. Am. J. Med. 80(4B):29-33
  4. ^ "Data Sheet: Voltaren Rapid 25". Information for Health Professionals. Medsafe - New Zealand Medicines and Medical Devices Safety Authority. 2007-07-10. http://www.medsafe.govt.nz/profs/datasheet/v/voltarenrapidtab.htm. Retrieved 2009-03-17. 
  5. ^ Dutta NK, Annadurai S, Mazumdar K, Dastidar SG, Kristiansen JE, Molnar J, Martins M, Amaral L (2000). "The anti-bacterial action of diclofenac shown by inhibition of DNA synthesis". Int. J. Antimicrob. Agents 14 (3): 249–51. doi:10.1016/S0924-8579(99)00159-4. 
  6. ^ Mazumdar K, Dutta NK, Dastidar SG, Motohashi N, Shirataki Y (2006). "Diclofenac in the management of E. coli urinary tract infections". In Vivo 20 (5): 613–619. PMID 17091768. 
  7. ^ Dutta NK, Annadurai S, Mazumdar K, Dastidar SG, Kristiansen JE, Molnar J, Martins M, Amaral L. (2007). "Potential management of resistant microbial infections with a novel non-antibiotic: the anti-inflammatory drug diclofenac sodium". Int. J. Antimicrob. Agents 30 (3): 242–249. doi:10.1016/j.ijantimicag.2007.04.018. 
  8. ^ Dutta NK, Mazumdar K, Dastidar SG, Park JH (2007). "Activity of diclofenac used alone and in combination with streptomycin against Mycobacterium tuberculosis in mice". Int. J. Antimicrob. Agents 30 (4): 336–340. doi:10.1016/j.ijantimicag.2007.04.016. 
  9. ^ a b Naidoo V, Swan GE (August 2008). "Diclofenac toxicity in Gyps vulture is associated with decreased uric acid excretion and not renal portal vasoconstriction". Comp. Biochem. Physiol. C Toxicol. Pharmacol. 149: 269. doi:10.1016/j.cbpc.2008.07.014. PMID 18727958. 
  10. ^ Kearney P, Baigent C, Godwin J, Halls H, Emberson J, Patrono C (2006). "Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials". BMJ 332 (7553): 1302–8. doi:10.1136/bmj.332.7553.1302. PMID 16740558. 
  11. ^ Solomon D, Avorn J, Stürmer T, Glynn R, Mogun H, Schneeweiss S (2006). "Cardiovascular outcomes in new users of coxibs and nonsteroidal antiinflammatory drugs: high-risk subgroups and time course of risk". Arthritis Rheum 54 (5): 1378–89. doi:10.1002/art.21887. PMID 16645966. 
  12. ^ FitzGerald G, Patrono C (2001). "The coxibs, selective inhibitors of cyclooxygenase-2". N Engl J Med 345 (6): 433–42. doi:10.1056/NEJM200108093450607. PMID 11496855. 
  13. ^ Graham D (2006). "COX-2 inhibitors, other NSAIDs, and cardiovascular risk: the seduction of common sense". JAMA 296 (13): 1653–6. doi:10.1001/jama.296.13.jed60058. PMID 16968830. http://jama.ama-assn.org/cgi/content/full/296/13/1653. 
  14. ^ http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm193047.htm
  15. ^ a b Brater DC (2002). "Renal effects of cyclooxygyenase-2-selective inhibitors". J Pain Symptom Manage 23 (4 Suppl): S15–20; discussion S21–3. doi:10.1016/S0885-3924(02)00370-6. PMID 11992745. 
  16. ^ www.merck.com/mmpe/sec11/ch131/ch131b.html?qt=diclofenac&alt=sh#sec11-ch131-ch131b-174
  17. ^ Oaks JL, Gilbert M, Virani MZ, Watson RT, Meteyer CU, Rideout BA, Shivaprasad HL, Ahmed S, Chaudhry MJ, Arshad M, Mahmood S, Ali A, Khan AA (2004). "Diclofenac residues as the cause of vulture population decline in Pakistan". Nature 427 (6975): 630–3. doi:10.1038/nature02317. PMID 14745453. 
  18. ^ a b Press Information Bureau, Government of India (2005-05-16). "Saving the Vultures from Extinction". Press release. http://pib.nic.in/release/release.asp?relid=9303. Retrieved 2006-05-12. 
  19. ^ a b c Swan G, Naidoo V, Cuthbert R, Green RE, Pain DJ, Swarup D, Prakash V, Taggart M, Bekker L, Das D, Diekmann J, Diekmann M, Killian E, Meharg A, Patra RC, Saini M, Wolter K (2006). "Removing the threat of diclofenac to critically endangered Asian vultures". PLoS Biol 4 (3): e66. doi:10.1371/journal.pbio.0040066. PMID 16435886. 
  20. ^ Gill, V. New drug threat to Asian vultures BBC News December 9, 2009.
  21. ^ Rabies follows disruption in food cycle
  22. ^ Schwaiger et al. (2004). Aquat. Toxicol. 68(2): 141-150
  23. ^ Triebskorn et al. (2004). Aquat. Toxicol. 68(2): 151-166
  24. ^ Schwaiger & Triebskorn (2005). UBA-Berichte 29/05: 217-226
  25. ^ Triebskorn et al. (2007). Analyt. Bioanalyt. Chem. 387(4):1405–1416
dyclo

External links


Simple English

Diclofenac is a non-steroidal ant-inflammatory drug. It can be used as an analgesic. It is often used to treat bruises and strain injuiries.


Citable sentences

Up to date as of December 14, 2010

Here are sentences from other pages on Diclofenac, which are similar to those in the above article.








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