Diclofenac
Diclofenac (marketed as Voltaren® and Cataflam®) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation, such as in arthritis or acute injury. It can also be used to reduce period pain.
Chemistry
The chemical name of the active compound is 2-[(2,6-dichlorophenyl)amino]benzeneacetic acid. Its molecular formula is C14H11Cl2NO2.
The difference between the specialités Voltaren and Cataflam is that Voltaren is the sodium salt of diclofenac, and Cataflam is the potassium salt.
Mechanism of action
The exact mechanism of action is not entirely known, but it is thought that the primary action responsible for its anti-inflammatory/antipyretic/analgesic action is through inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX).
Diclofenac, it seems, may also be a unique member of the NSAIDs. There is some evidence that diclofenac inhibits the lipooxygenase pathways, thus reducing formation of the leukotrienes (also pro-inflammatory autacoids). There is also some speculation that diclofenac may inhibit phospholipase A2 as part of its mechanism of action. These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a molar basis.
Inhibition of COX also decreases prostaglandins in the epithelium of the stomach, making it more sensitive to corrosion by gastric acid. This is also the main side-effect of diclofenac and other drugs that are not selective for the COX2-isoenzyme.
Uses
Diclofenac is used for musculoskeletal complaints, especially arthritis (rheumatoid arthritis and osteoarthritis).
As long-term use of diclofenac and similar NSAIDs predisposes for peptic ulcer, many patients at risk for this complication are prescribed a combination (Arthrotec®) of diclofenac and misoprostol, a synthetic prostaglandin analogue, to protect the gastric mucosa.
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