Osteoarthritis and rheumatoid arthritis are treated managed with various medications including non-steroidal anti-inflammatory drugs. One of the popular medications in use since the last three decades is diclofenac, which has effectively become the first line of therapy for managing symptoms associated with the above conditions. Belonging to the category of phenylacetic acid derivative and NSAID, diclofenac has a mechanism of action that makes it suitable as combination medication for helping prevent gastric ulcers that are typically attributed to NSAIDs. Here is an in-depth look at the medication, an overview of the mechanism of action, commonly reported side effects of diclofenac and simple measures to mitigate the undesirable outcomes.
Overview of the NSAID and mechanism of action
The mechanism of action of diclofenac is one of the reasons for its choice as first line therapy for managing various conditions. COX-1 and COX-2 are enzymes that facilitate the production of prostaglandins, which in turn are responsible for inflammation and pain stimuli. The inhibition of COX-1 and COX-2 by NSAIDs helps in managing chronic pain and inflammation that is associated with the two conditions. This inhibition of COX-1 and -2 is the primary outcome, that helps in handling pain, as the relatively broad activity of prostaglandins triggers pain signaling among patients with the condition. Painful inflammatory conditions in osteoarthritis and rheumatoid arthritis are mainly due to the sequence of actions of prostaglandins. Diclofenac also helps in reducing the sensitization in pathways, and brings about significant reduction in inflammatory pain.
In addition to the above two conditions, the medication is used for treating sprains in muscles and strains in ligaments/muscles. Individuals suffering from back pain are also recommended diclofenac in various forms to help alleviate the pain. The medication finds use in dental conditions, such as tooth ache, apart from helping reduce pain from headaches and migraine. It is also recommended for patients diagnosed with gout. Finally, the medication is also used in the treatment/management of the inflammation of the spine in a condition medically known as ankylosing spondylitis.
The medication is available in various forms – oral, topical, injections and eye drops. The tablets, are available in slow-release formulations, apart from capsules and suppositories. The topical application includes gel and plasters. Finally, diclofenac is also administered as an injection in hospitals, apart from eye drops for certain conditions.
General precautions while taking the medication
Studies have been conducted in the past regarding the effects of diclofenac on birds that fed on carcasses of animals that were treated with diclofenac. The results of studies indicate that the birds died of kidney failure as a result of consuming the flesh of animals that received diclofenac as vet treatment. It is therefore necessary to exercise certain level of caution when on the medication. Ideally, it is recommended to limit the use of the medication to the shortest possible time, and stick to the least dosage necessary to manage the condition.
The medication is best taken with food, or after finishing food. Individuals who take the medication before food are likely to experience some kind of sickness or nausea. The topical applications, such as gel or plasters are not to be used more than twice a day, to avoid possible undesirable effects.
The medication is ideally taken twice or thrice a day. Depending on the condition being treated with diclofenac and other conditions or medications used by the patient, the dosage could be either 75 mg or 150 mg per day. In the event of patients requiring medication for pain that is persistent in nature, specialists prescribe slow-release formulations. The dosage considerations of children are generally on the basis of body weight of the child. Diclofenac is ideally taken with milk, and patients who prefer water over milk are advised to take it either after a meal or with a meal. Use of suppositories are as per standard procedures – for instance, the hygiene requirements, the depth of insertion and the need to remain motionless till the suppository melts.
Patients who use diclofenac gel are advised to ensure that usage does not exceed four times a day, depending on the strength of the gel. There needs to be a clear gap of at least 04 hours between two applications. Application of the gel does not require intense rubbing or massaging motion. It needs to be applied and gently rubbed, slowly for a very short time. Individuals who choose to use diclofenac patches are advised to restrict usage to a maximum of 2 areas at any given time. For instance, if the patient experiences pain in four different areas of the body, the plaster is to be applied only on two areas at a time, with the other two areas treated the next time. Use of multiple plasters at the same time will increase the amount of diclofenac in the body beyond safe limits.
The possibility of missing a dose exists with medications that are taken on a long-term basis. Patients who miss a dose are expected to follow a simple rule of thumb to avoid unwanted side effects. For instance, at no point of time should a patient take a double dose in an attempt to make up for a missed dose. In the event that a dose of any medication prescribed to be taken once daily is missed, the patient can take one dose immediately, only if there is a gap of twelve hours to the next scheduled dose. If the time of noticing the missed dose is within twelve hours of the next dose, it is best to skip it.
Dealing with undesirable outcomes of diclofenac
As mentioned above, undesirable outcomes of medications are common to all medications and formulations. It is necessary to be aware of simple methods to mitigate and reduce the effects attributed to medications. For instance, individuals on diclofenac who experience feelings of nausea are advised to take the medication either with a meal or after a meal. This will help prevent nausea. Patients with bouts of vomiting or diarrhea when on diclofenac are advised to intake adequate water/fluids. This is to be ideally taken in small amounts, frequently. The patient is also advised to check for indications of dehydration and consult a specialist if the same is confirmed. For instance, a decrease in the amount of urine passed, or discoloration in urine, or a pungent strong odor when passing urination are all possible indications of dehydration.
Side effects of the medication include the possibility of vertigo or a dizzy feeling. This is typically experienced during the initial stages of taking the medication, which would resolve naturally over short period. Till the time that the effects resolve, patients are advised to avoid operating heavy machinery or equipment that require complete control at all times. Driving is also to be avoided; till the time the effects wear off completely. Similarly, individuals are also likely to experience headaches during the initial week of starting diclofenac. The best option to deal with this effect is to increase fluid intake and avoid alcohol.
A possible embarrassing outcome of the medication is the possibility of flatulence or passing wind. This may or may not be accompanied by a clear loss of appetite. To deal with this, it is necessary to avoid food and food products that could contribute to flatulence. For instance, onions, lentils, and beans are all known to cause flatulence. Individuals are to avoid these food products and consume smaller portions, apart from taking time to chew food properly, slowly.
Visible manifestations of the side effects of the medication include outbreak of rashes on the skin or dry skin. Individuals may also experience itching sensation on the skin. A simple emollient will help to hydrate and nourish the skin, helping overcome the dry and parched appearance of the skin. The patient’s skin is also likely to be more sensitive to light when on the medication. It is necessary to avoid bright sunlight, especially when it is around noon. Individuals are advised to choose a good sun screen lotion and use the product on all days till the time, the issue is resolved. Patients are advised to avoid choosing popular options such as tanning or sunbathing during this period.
Categories of individuals advised to avoid the medication
Here is a compilation of categories of individuals who can safely take the mediation and certain categories of individuals advised to avoid the medication. Most adults and children can safely take the medication, in various forms, for the prescribed period. Individuals who are advised to either avoid the medication or seek medical advice regarding use of the NSAID include the following categories. Patients who have had allergic reactions in the past to either diclofenac or medications with similar mechanism of action/ingredients.
Individuals with a history of allergies to aspirin or NSAIDs are also advised to avoid diclofenac, to prevent undesirable outcomes. Patients who have experienced certain adverse effects such as asthma, wheezing, inflammation of the skin, outbreak of rashes or a running nose when on NSAIDs are also advised to stay off diclofenac. Patients diagnosed with stomach ulcers, or internal bleeding in the stomach or the intestines are also precluded from the category of individuals who can be prescribed diclofenac. Other categories of patients considered unsafe or unsuitable for taking the medication include individuals with hypertension, and patients with blood clotting disorder.
Similarly, patients with lupus, are also considered as unsuitable for using diclofenac. The auto immune disease is a condition with no present cure and requires treatment extends till end of lie of the patient. This condition causes organ damage, rashes on the skin and pain in the joints, and is known to typically affect women below the age of 45 years. Women who are either pregnant, planning a pregnancy or breastfeeding are also advised to avoid the medication due to the documented effects. Other conditions include individuals diagnosed with Crohn’s disease and patients suffering from renal ailments, liver diseases and with a history of heart diseases.
Symptoms experienced with overdose of diclofenac
Patients who take excessive dosage of the medication in any form, are most likely to experience certain symptoms indicative of overdose. For instance, pain in the stomach, bouts of diarrhea or vomiting sensations are commonly experienced symptoms. Other symptoms include possible traces of blood in the vomit or feces, or discoloration of feces/vomit. A ringing sensation in the ear is another possibility, while some typically experience a drowsy feeling, and throbbing headaches.
