Diclofenac (topical)

Diclofenac (dye-kloe’-fen-ak) topical is a NSAID that is widely used. Diclofenac is also available orally, rectally and as an injectable. Topically, Diclofenac gel (3%) is indicated for actinic keratoses and Diclofenac cream (1%) is indicated for musculoskeletal symptoms.

Mechanism of action:
inhibition of prostaglandin synthesis through COX-inhibition -inhibits COX-1 and COX-2 with relative equipotency.

It is not clear how diclofenac gel works in treating actinic keratoses

Pharmacokinetics:
When applied topically it is absorbed into the epidermis and only very small small amounts of diclofenac and its metabolites can be detected in the plasma.
When taken orally, diclofenac and its metabolites are excreted mainly in the urine.

Contraindications:
Hypersensitivity to diclofenac or any ingredient in the formulation
Open wound or skin infection.

Precautions:
Wash hands after applying.
Use with caution in those with gastrointestinal ulceration or bleeding and with severe renal or liver impairments.
The safety of diclofenac has not been established for use during pregnancy.

Interactions:
Do not use if taking ketorolac, as it might increase the risk of gastrointestinal tract side effects.

Side Effects:
Most common are a burning sensation, itching, redness, dry skin and a skin rash at the site of application.

Brand names: Voltaren Emulgel, Voltaren Topical, Solaraze, Pennsaid, Rexaphenac and others
Chemical formula: C14H11Cl2NO2

Systematic Reviews and Meta Analysis:

In Australia, Diclofenac is on the National Podiatry Scheduled Medicines List.

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