Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) primarily used to relieve pain, reduce inflammation, and lower fever. The medication works by inhibiting cyclooxygenase (COX) enzymes within the body to decrease the production of inflammatory mediators, thereby alleviating discomfort caused by arthritis, muscle pain, or tissue injury.
Its clinical applications include management of acute pain (such as postoperative pain and dental pain) and chronic inflammatory diseases (such as osteoarthritis and rheumatoid arthritis). This drug can be administered orally or topically, with formulations including capsules, tablets, patches, and injections, offering rapid onset and broad applicability.
The generic name for diclofenac is "Diclofenac Sodium" or "Diclofenac Calcium." Common brand names include:
Different formulations may have different brand names, but the active ingredient remains diclofenac. Patients should verify that the generic name on the label matches the physician’s prescription.
Diclofenac is classified as an "NSAID" (Nonsteroidal Anti-Inflammatory Drug), similar to ibuprofen. These drugs inhibit cyclooxygenase enzymes (COX-1 and COX-2) selectively or non-selectively to block prostaglandin synthesis, achieving anti-inflammatory, analgesic, and antipyretic effects.
Unlike corticosteroids, diclofenac does not suppress the immune system but may increase gastrointestinal and cardiovascular risks, so it should be used under medical supervision.
This medication is mainly used for the following symptoms and conditions:
In certain cases, topical formulations can target local pain (such as tendinitis), reducing systemic side effects. Physicians may adjust the formulation and dosage based on the patient’s medical history.
Mild side effects include:
Serious side effects require immediate medical attention:
If you experience any of the above symptoms, stop the medication immediately and contact healthcare professionals.
Contraindications include:
The FDA black box warning indicates that long-term use may increase the risk of heart attack and stroke. Patients over 65 or with a history of cardiovascular disease should exercise particular caution. Use during early and mid-pregnancy should be evaluated by a physician, and breastfeeding may need to be temporarily discontinued.
Concurrent use with the following medications may increase risks:
Taking antiplatelet drugs (such as aspirin) simultaneously may reduce diclofenac’s effectiveness. Certain herbal supplements (such as ginkgo or ginseng) may also increase bleeding risk. Patients should inform their healthcare provider of all medications they are using.
Oral formulations are typically recommended at 25-50 mg per dose, 2-3 times daily, with a maximum daily dose of 150 mg. Patches should be replaced every 24 hours to prevent overdose absorption. Taking with food can help reduce gastrointestinal discomfort.
Dosage should be adjusted based on age, liver and kidney function, and underlying health conditions. Do not increase the dose or extend use beyond prescribed duration. If used continuously for more than 10 days, re-evaluate the condition. Topical formulations should not exceed the recommended coverage area to avoid excessive absorption.
If a dose is missed and more than 4 hours remain before the next scheduled dose, take the missed dose immediately; if it is close to the next dose, skip the missed dose and resume the normal schedule. Do not double doses to make up for missed ones, as this may cause poisoning.
If long-term missed doses lead to worsening pain, contact a healthcare provider rather than adjusting the dose yourself. Patients with chronic conditions should establish a medication reminder system (such as pillboxes or mobile alerts) to prevent missed doses.
Overdose may cause severe side effects, including:
If overdose is suspected, seek immediate medical attention and bring the medication container for reference. Emergency treatments may include gastric lavage, activated charcoal absorption, or hemodialysis. Do not induce vomiting at home to avoid further harm.
How can I reduce gastrointestinal discomfort when taking diclofenac?
It is recommended to take the medication with food or after meals to minimize gastric mucosal irritation. If symptoms like heartburn, vomiting, or black stools occur, stop the medication and seek medical attention. Long-term users should consult their doctor about the possible need for gastric mucosa protectants.
Can I take anticoagulants while using diclofenac?
Concurrent use with anticoagulants like warfarin may increase bleeding risk. Doctors will adjust the dose based on coagulation function and recommend regular monitoring of INR. Patients should inform their healthcare provider if they are using anticoagulants for short-term pain relief.
What is the effect of alcohol consumption during diclofenac treatment?
Alcohol can exacerbate gastrointestinal mucosal damage caused by the medication, increasing the risk of ulcers and bleeding. It is advisable to avoid alcohol entirely during treatment, especially during acute inflammation or pain episodes, following strict abstinence guidelines.
Why might long-term use of diclofenac cause edema or increased blood pressure?
NSAIDs inhibit prostaglandin synthesis, which may activate the renin-angiotensin-aldosterone system, leading to water retention, increased blood pressure, or worsening of congestive heart failure. Patients with hypertension should be evaluated by a doctor before use and regularly monitored for blood pressure changes.
What are the differences between topical patches and oral tablets of diclofenac?
Topical patches are absorbed locally, reducing systemic side effects, making them suitable for mild arthritis. However, they may cause skin allergies or irritation. Oral formulations provide stronger pain relief but require liver and kidney function monitoring. Elderly patients or those with chronic illnesses should choose formulation and dosage based on medical advice.
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