Diclofenac

Widely used NSAID (non-steroidal anti-inflammatory drug: market share approx. 65%) with pronounced analgesic, antipyretic, antiphlogistic opioid-sparing effect. Also possible as an analgesic enhancing additive to paracetamol or metamizole (balanced analgesia).

Very potent antiphlogistic analgesic (10-20 times more potent against COX-2 than against COX-1).

Inflammation, painful swelling, rheumatoid arthritis, arthrosis.

Since increased COX 2 levels in carcinoma in situ, type "actinic keratosis" can be detected (also in spinocellular carcinomas), a 3% local therapeutic agent (diclofenac-hyaluronic acid gel) is successfully used for actinic keratoses.

2 times/day 50-150 mg p.o., i.m., i.v.

Systemic therapy: gastrointestinal ulcers, exanthema, photosensitivity.

With local application: redness, itching and rarely allergic contact reactions.

• Voltaren®, Duravolten®, Effekton®, Diclofenac-ratiopharm®.
• Solaraze® (local therapeutic agent)

The combination of diclofenac with another mixed NSAID like ibuprofen/naproxen (inhibition of cyclooxygenases 1 and 2) or a selective COX-2 inhibitor like parecoxib is contraindicated.

1. Jage J (2009) Key questions on the therapy of postoperative pain. Georg Thieme Publishing House, Stuttgart S.16-21
2. Merk HF (2007) Topical diclofenac in the treatment of actinic keratoses. Int J Dermatol 46: 8-12