Diclofenac
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied Health
• Diclofenac decreases the amount of calcium lost in the urine,1 which may help prevent bone loss in postmenopausal women.21
• Diclofenac causes complex changes to L-tryptophan levels in the blood,3 but the clinical implications of this are unknown. More research is needed to determine whether supplementation with L-tryptophan is a good idea for people taking diclofenac2
• Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression. Diclofenac may inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral.4 Since minor changes in lithium blood levels can produce unwanted side effects, diclofenac should be used with caution in people taking lithium supplements.3
• Taking diclofenac with food may lower the maximum concentration of the drug in the blood and may delay, but not decrease, absorption.8 NSAIDs such as diclofenac should be taken with a meal to reduce stomach irritation.4
• Injury to the stomach caused by NSAIDs such as diclofenac can resolve naturally despite continued administration of the drug. However, the stomach lining of smokers is less likely to adapt to injury, leading to continued damage from the drug.95
• Chronic consumption of alcohol can aggravate injury to the stomach and duodenal lining caused by diclofenac. To prevent added injury, consumption of alcoholic beverages should be avoided in individuals taking diclofenac.6
• In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.5 More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.7
• Trikatu, an Ayurvedic herbal preparation that contains Piper nigrum (black pepper), Piper longum (Indian Long pepper), and Zingiber officinale (ginger), decreased both blood levels and the medicinal effect of diclofenac in a study in rabbits.68
• Willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of aspirin to individuals taking diclofenac results in a significant reduction in blood levels of diclofenac. Though there are no studies investigating interactions between willow bark and diclofenac, people taking the drug should avoid the herb until more information is available.9
References1 Sharma S, Vaidyanathan S, Thind SK, et al. The effect of diclofenac sodium on urinary concentration of calcium, uric acid and glycosaminoglycans in traumatic paraplegics. Br J Urol 1991;68:240–2.
1 Bell NH, Hollis BW, Shary JR, et al. Diclofenac sodium inhibits bone resorption in postmenopausal women. Am J Med 1994;96:349–53.
2 Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.
3 Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.
4 Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.
5 Lipscomb GR, Campbell F, Rees WD. The influence of age, gender, Heliobacter pylori and smoking on gastric mucosal adaptation to non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 1997;11:907–12.
6 Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2889–91.
7 Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105–8.
8 Lala LG, D'Mello PM, Naik SR. Pharmacokinetic and pharmacodynamic studies on interaction of Trikatu with diclofenac sodium. J Ethnopharmacol 2004;91:277–80.
9 Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.
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Disclaimers
The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.
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