Pain and inflammation – a typical field of application for the active ingredient Diclofenac. Therefore, Diclofenac helps especially in chronic joint diseases such as rheumatism or sports injuries such as strains and bruises. Compared with acetylsalicylic acid and paracetamol, the active ingredient diclofenac is one of the rather younger drugs: diclofenac has been on the market since 1974. The acetic acid derivative is one of the most commonly used painkillers – every year, manufacturers in Germany generate sales of around 130 million euros with the active ingredient diclofenac.
Effect of diclofenac
Diclofenac is classified in the group of so-called cyclooxygenase inhibitors (non-opioid analgesics), i.e. painkillers that are not opiate derivatives. Since diclofenac has a very good anti-inflammatory (anti-inflammatory) effect, it is also classified – like ibuprofen – as a non-steroidal anti-inflammatory drug, i.e. an anti-inflammatory drug that does not contain steroids such as cortisone. Since such drugs work particularly well in rheumatic diseases, they are also called non-steroidal anti-inflammatory drugs (NSAIDs). Painkillers: which one, when and for what?
Active ingredient in analgesic
The active ingredient diclofenac is used internally and externally for the treatment of mild to moderate acute and chronic pain – especially if it is caused by inflammation or accompanied by fever. Disease patterns for which the active ingredient is frequently prescribed are:
- Rheumatic diseases such as chronic polyarthritis or osteoarthritis.
- Acute attacks of gout
- Joint injuries during sports
- Pain and swelling after surgery
- Herniated discs or
- Period pain
The effect begins quite quickly – about 30 to 60 minutes after ingestion – and lasts about four hours (about twelve hours for the retard tablets, which release the active ingredient diclofenac more slowly).
How does diclofenac work?
Diclofenac inhibits the body’s cyclooxygenases Cox-1 and Cox-2:
- Cox-2, in particular, is activated during cellular damage and cranks up the production of prostaglandins that promote inflammation and increase pain. The desired effect of diclofenac is mainly based on their inhibition.
- Cox-1, on the other hand, increases the production of prostacyclin, which protects the gastric mucosa. Therefore, the stomach-damaging side effects of diclofenac result.
Dosage of diclofenac
The active ingredient Diclofenac – mainly known as Voltaren – is commercially available in various dosage forms:
- For internal use as tablets, capsules, dragées and drops, and as suppositories or injectable solutions.
- For external use as an ointment, gel or patch and as eye drops.
All preparations are subject to prescription in Germany pharmacies, depending on the amount of active ingredient contained and dosage form. The maximum daily dose for tablets is 150 mg, which is divided into three to four single doses for the normal tablets, and two single doses for the retard preparations.
Side effects of diclofenac
The main side effects of diclofenac are gastrointestinal problems: Loss of appetite, diarrhea, nausea, stomach pain; there is an increased risk of stomach ulcers and gastric bleeding and even gastrointestinal rupture. In patients with appropriate sensitivity, diclofenac is always given along with a gastroprotective preparation because of these side effects. Less common side effects include impaired renal function, increased blood pressure, and increased bleeding tendency. Diclofenac can also damage the liver as a side effect, especially if potentially liver-damaging substances (for example, drugs for seizure disorders) are taken at the same time or if alcohol abuse is present. Rarely, spasm of the airways with shortness of breath occurs as one form of side effect of diclofenac.
Does diclofenac increase the risk of heart attack?
Several years ago, newer NSAIDs that specifically inhibit Cox-2 (coxibe) were withdrawn from the market because they increase the risk of heart attack. Subsequently, the “old” non-selective NSAIDs such as diclofenac and ibuprofen were also analyzed – and here, too, this relationship is demonstrable. Since then, research has been conducted on this topic – so far without conclusive results, especially since there are no satisfactory treatment alternatives for many diseases.However, Danish researchers have found that diclofenac increases the risk of heart attack, heart failure, and stroke.
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The risk of serious cardiovascular events was especially increased in people with diabetes or heart failure and in people who had already had a heart attack. The researchers therefore recommend that use be carefully weighed and that diclofenac be classified as prescription-only in the future.
Important information about the active ingredient diclofenac.
Consider the following advice when using diclofenac:
- Always take the lowest possible dose of diclofenac; discuss dosage with a doctor.
- Do not exceed recommended maximum amount of diclofenac.
- Do not combine diclofenac with other NSAIDs such as ibuprofen, as their side effects may increase.
- If taking diclofenac for a long time, have blood pressure, kidney and liver values checked regularly.
- Children and adolescents, asthma sufferers and pregnant women should not take diclofenac.
Sharp pain
