Diclofenac chemical structure
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Voltaren

Diclofenac (marketed as Voltaren®, Voltarol® and Cataflam®) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation, such as in arthritis or acute injury. It can also be used to reduce menstrual pain. more...

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Voltaren and Voltarol contain the sodium salt of diclofenac. 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. Diclofenac is available in stomach acid resistant formulations (25 and 50 mg), fast disintegrating oral formulations (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 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. OTC use is approved for minor aches and pains and fever associated with common infections.

Diclofenac is available as a generic drug in a number of formulations.

Mechanism of action

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).

Diclofenac, it seems, may also be a unique member of the NSAIDs. There is some evidence that diclofenac inhibits the lipooxygenase pathways, thus reducing formation of the leukotrienes (also pro-inflammatory autacoids). There is also speculation that diclofenac may inhibit phospholipase A2 as part of its mechanism of action. These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a molar basis.

Inhibition of COX also decreases prostaglandins in the epithelium of the stomach, making it more sensitive to corrosion by gastric acid. This is also the main side effect of diclofenac. 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.

The action of one single dose is much longer (6 to 8 hours) than the very short half-life of the drug indicates. This could partly be due to a particular high concentration achieved in synovial fluids.

Common uses

Diclofenac is used for musculoskeletal complaints, especially arthritis (rheumatoid arthritis, osteoarthritis, spondylarthritis, ankylosing spondylitis), gout attacks, and pain management in case of kidney stones and gallstones. An additional indication is the treatment of acute migraines. Diclofenac is used commonly to treat mild to moderate post-operative or post-traumatic pain, particular when inflammation is also present, and is effective against menstrual pain.

Read more at Wikipedia.org


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New neuropathy treatment guidelines - Brief Article
From AIDS Treatment News, 11/28/03 by John S. James

An expert panel has recommended five different kinds of drugs that are suitable for treating neuropathy pain in some patients. The review and recommendations were published in the November issue of Archives of Neurology(l). These guidelines mention HIV but are not HIV-specific. They are available free on the Web (at least when we checked on December 1, 2003) at: http://archneur.ama-assn.org/cgi/content/full/60/11/1524

From the article:

"First-lineMedications. The efficacy of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants (TCAs) has been consistently demonstrated in multiple randomized controlled trials. Each one can be used as an initial treatment for neuropathic pain in certain clinical circumstances. Opioid analgesics and TCAs generally require greater caution than the other options. For each of these 5 medications, brief reviews of the relevant randomized clinical trials and specific treatment recommendations follow. Treatment recommendations are summarized in Table 2."

Not recommended but sometimes used are NSAIDS; many experts believe they are not effective for this kind of pain.

(However, AIDS Treatment News has heard anecdotal reports of relief with Voltaren Emulgel, an NSAID in a topical formulation. The topical form is not sold in the U.S., but may be available from Internet pharmacies for under $20. See our 1999 article at: http://www.aids.org/atn/a-321-01.html)

The same issue of Archives of Neurology also has an article on surgical treatment for neuropathy pain(2), and an editorial(3).

References

(1.) Dworkin RH, Backonja M, Rowbotham MC, and others. Advances in Neuropathic Pain: Diagnosis, Mechanisms, and Treatment Recommendations. Archives of Neurology. November 2003; volume 60, number 11, pages 1524-1534

2. Giller CA. The Neurosurgicai Treatment of Pain. Archives of Neurology. November 2003; volume 60, number 11, pages 1537-1540.

3. Rosenberg RN. Pain 2003. Archives of Neurology. November 2003; volume 60, number 11, page 1520.

COPYRIGHT 2003 John S. James
COPYRIGHT 2003 Gale Group

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