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Diclofenac

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Generic and proprietary names

- Diclofenac.

- Voltarol.

- Voltarol Rapid.

- Voltarol Retard.

- Diclomax SR.

- Diclomax Retard.

- Motifene.

- There are also other brands of modified release or combined formulation diclofenac.

Action

- Inhibits an enzyme needed for prostaglandin synthesis resulting in decreased levels.

Classification

- Non-steroidal anti-inflammatory drug (NSAID).

Indications

- Pain and inflammation in rheumatic disease, musculoskeletal disorders, acute gout and following surgery.

Contraindications

- Porphyria.

- Active peptic ulceration.

- Hypersensitivity including hypersensitivity to other NSAIDs or aspirin.

Cautions

- Severe renal disease.

- Severe hepatic disease.

- History of peptic ulceration.

- Breastfeeding.

- Older people.

- Coagulation problems.

Side-effects

- Gastrointestinal problems including ulceration.

- Hypersensitivity reactions.

- Headache.

- Dizziness.

- Depression.

- Drowsiness.

- Sleeping problems.

- Hearing disturbance.

- Photosensitivity.

- Haematuria.

- Fluid retention.

- Raised blood pressure.

- Papillary necrosis.

- Hepatic damage.

- Alveolitis.

- Pulmonary eosinophilia.

- Pancreatitis.

- A recent study (Hippisley-Cox, 2005) has suggested an increased risk of myocardial infarction. 

Interactions

- Increased risk of renal impairment with ACE inhibitors.

- Increased risk of bleeding with some antidepressants or anticoagulant medications.

- The possible enhancement of phenytoin.

- May reduce excretion of methotrexate, baclofen, digoxin and lithium.

Administration

- Oral - tablets, dispersible tablets or capsules.

- Injection.

- Suppositories.

- Gel.

Patient teaching

- Onset of pain relief is about one hour depending on route of administration. l Full anti-inflammatory effect may take up to three weeks.

- Take oral preparations with food and keep alcohol consumption low to decrease risk of stomach irritation.

- If using as a long-term treatment for arthritis, consult the prescribing professional before stopping it.

- Do not take any other NSAIDs.

Nursing considerations

- Evaluate therapeutic response by assessing pain, joint stiffness, joint swelling and mobility.

- Assess any worsening of asthma in appropriate patients.

- Regular full dosage has both lasting analgesic and anti-inflammatory effects, making it useful for continuous pain associated with inflammation.

- Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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