Side effects of diclofenac
introduction
Despite the fact that the active ingredient diclofenac is actually well tolerated, some side effects can occur, especially with long-term use.
Taking a high dose also plays a role here. The higher the dose of diclofenac and the more frequently it is taken, the higher the risk of side effects occurring.
Effects on the gastrointestinal tract
Probably best known side effect of Diclofenac presents an undesirable effect on the Gastrointestinal tract represent.
The reason is that by pharmacological inhibition of the enzyme Cyclooxygenase also the gastric protective mucous membrane of the stomach is no longer built up as quickly as it should. Stomach acid on the other hand, the usual quantities are still being produced and so come in direct contact with the thinning Gastric mucosa. After long-term use of diclofenac it can happen that parts of the stomach wall are completely unprotected and come into direct contact with the corrosive stomach acid. It comes to one Ulcer (Gastric ulcer), what with severe pain can go hand in hand. The most feared side effect of using Diclofenac is that Gastric bleedingthat immediately also partially intensive care needs to be treated.
Before every treatment with Diclofenac the patient should definitely be informed about this side effect and above all be asked whether he already has one Gastric ulcer had or is still up to date. If this is answered in the affirmative, the use of diclofenac or other preparations that work via a similar mechanism must be carefully considered and, if necessary, alternative preparations must be used. If it is not known whether the patient has a gastric ulcer or not, if in doubt, consideration should be given to the solid medication with diclofenac Gastroscopy to be carried out in order to treat stomach ulcers (ulcers) or older bleeding in the area of the Stomach area and des Duodenum to exclude.
Often times it doesn't come to one Gastric bleedingbut too simple Stomach discomfortthat as stomach pressure or stomach pain can be specified. If this is expressed by the patient, consideration can be given to discontinuing Diclofenac and exchanging it for an alternative preparation or an additional one Stomach protection tablet to be added to the diclofenac, which should inhibit the gastric acid which is harmful in this case. Here come so-called Proton pump inhibitors, such as. Pantoprazole is used. There can be a dosage of at the beginning 20 mg be chosen and then seen whether this dosage is sufficient or on 40 mg needs to be increased.
Effects on the cardiovascular system
What is relatively new is the realization that Diclofenac themselves negative on the Cardiovascular system can affect. Various studies that dealt with the use of diclofenac were evaluated and corresponding side effects were observed.
It could be shown that taking diclofenac to a Increase in dangerous vascular disease has come. This made itself felt by newly appeared Heart attacks or Strokes noticeable. Although the number of events was not dangerously high (which should have led to the discontinuation of diclofenac in the healthy population), it did leave the use of diclofenac in place pre-stressed patients appear more critical.
Some time ago were Warnings from pharmacological companies published showing that patients who already have a stroke or one Heart attack had been given diclofenac with extreme caution. In this case, the occurrence of a new infarct or stroke is too great.
Effects on general well-being
In addition to the first-mentioned, especially serious, possible side effects and risks when using Diclofenac, there may also be non-specific side effects that occur with many drugs. To be mentioned malaise, nausea, a headache and dizzinessthat should be taken seriously if they occur after taking diclofenac. in the In doubt should the preparation discontinued and be seen whether the symptoms go away or not.
Effects on the skin
Sometimes it can too Effects on the skin come under diclofenac. Here occur after taking a few days later Skin irritation and Eczema on, which is usually moderate to severe itch. All regions of the body can be affected, but most of all are poor, face and hull as preferred sites for rashes in a diclofenac reaction.
Effects on the stomach
One of the most common side effects of diclofenac is stomach upset. Some authors state that the stomach problems are more pronounced with diclofenac than with other pain relievers of the same substance class. Compared to ibuprofen and acetylsalicylic acid (ASA), the risk of gastric ulcers is relatively lower with diclofenac. All three drugs intervene in prostaglandin synthesis. They inhibit the so-called cyclooxygenases 1 and 2 (COX1 and COX2). However, the inhibition of the active ingredients is different. Acetylsalicylic acid inhibits COX 1 in particular, while ibuprofen inhibits both approximately equally and diclofenac inhibits COX 2 in particular. This has an impact on the different risk of side effects on the stomach. The COX 1 is normally found constitutively in certain areas of the body. For example, it is present in the kidneys, platelets and stomach. In the stomach, the COX 1 ensures that prostaglandins are released.
Read more on the topic: Stomach discomfort
These cause so-called bicarbonate ions to be formed. They cause mucus to form in the stomach. This leads to a protection against gastric acid in the stomach. If the COX 1 is now inhibited, the stomach protection falls away and stomach problems and stomach ulcers can occur. In particular, the inhibition of COX 1 plays a major role here. If glucocorticoids are taken in addition to the diclofenac, the risk of stomach ulcers increases. This is justified by the specific properties of the drugs. Glucocorticoids have a so-called antiproliferative effect. That means they delay wound healing. If, for example, the stomach has already been damaged by the diclofenac, glucocorticoids with their antiproliferative properties contribute to the fact that the lesion on the stomach does not heal. As a result, the risk of developing a gastric ulcer may be increased. It is advisable to discuss with your doctor how possible stomach problems can be minimized when taking Diclofeanc.
Effects on the intestines
Diclofenac can cause various intestinal side effects. For example, inflammation can develop on the protrusions of the colon lining. This inflammation is also called divericulitis. In particular are over 70 year olds or people with a weakened immune system. affected. This inflammation can be harmless. There may be temporary pain in the left lower abdomen. But it can also cause pain in the right or entire lower abdominal area. Fever, gas, nausea, diarrhea or constipation can also occur. However, when taking diclofenac it can sometimes be that the fever and pain are inhibited, so that mainly the intestinal problems express themselves. In other cases, intestinal cramps are in the foreground. In addition, gastrointestinal bleeding may occur while taking diclofenac.These show up in the black stool, the so-called tar stool. In the event of these complaints, a doctor should be consulted immediately.
Read more on the topic: Divericulitis
Effects on the kidney
Diclofenac can have a damaging effect on the kidneys, especially if taken for a long time. This can be explained by the inhibition of COX 1 and COX 2. The inhibition of COX 1 leads to a lower release of prostacyclins and prostaglandins in the kidney. As a result, blood flow to the kidneys deteriorates. This can reduce the kidney's filtering function. Inhibiting COX 2 can cause the blood flow in the renal arteries to be impeded. The COX 2 is constitutively present in the endothelial cells. The endothelial cells are constantly exposed to shear forces due to the pulse waves of the blood. The task of the COX 2 is to mitigate this. It does this by releasing prostacyline there. As a result, the blood vessels dilate, which means that the shear forces are “buffered”. This favors a physiological blood flow, among other things, in the renal arteries. Therefore, permanent or recurring use of diclofenac can permanently restrict kidney functions. .
Side effect sweating
Diclofenac has an antipyretic effect. In technical jargon, one speaks of an antipyretic effect. Therefore, diclofenac can cause sweating as a side effect. Normally, prostaglandins play an important role in causing a fever in our body. The inhibition of COX 1 and COX 2 prevent the synthesis of prostaglandins. As a result, the body eventually reacts with sweating due to various mechanisms.
Side effect high blood pressure
Diclofenac can also increase blood pressure. The inhibition of COX 1 leads to increased sodium retention in the kidneys and thus water reabsorption. The consequence is an increase in blood pressure. In addition, an inhibition of COX 2 leads to a reduced vasodilatation and this too can raise the blood pressure. According to this, diclofenac can reduce the effects of antihypertensive drugs, such as ACE inhibitors.
Read more on the topic: high blood pressure
Interaction with alcohol
Taking diclofenac and drinking alcohol at the same time should be avoided. There are several reasons why this combination is not recommended. The risk of a stomach ulcer increases. Liver and kidney damage can occur. In addition, the risk of blood tendency increases. Taking diclofenac and consuming alcohol at the same time can lead to unpredictable short-term and long-term damage.
Effect that changes the blood count
One more rare side effect but the effects of diclofenac on that are not harmless Blood count. These mainly occur after a Long-term use and are usually not noticed by the patient. For this reason, the blood of patients who have long and regularly taken diclofenac is important Blood test to undergo. Particularly at risk are people who high-dose amounts from Diclofenac take in. It should also be used in patients who are already taking Pre-existing blood disorders particularly suffer from one regular blood tests be respected.
How long do the side effects last?
When it comes to the duration of side effects, a distinction must be made between short-term and long-term side effects. The short-term side effects such as sweating disappear when you stop taking the drug or when the fever has been fought. Most long-term side effects only occur with long-term use of diclofenac. In these cases permanent restrictions can arise, for example on the kidneys or on the heart. Diclofenac should only be taken for a short time and in small amounts. If long-term intake is necessary, for example in the context of rheumatoid arthritis, the intake should be discussed in detail with the doctor.
Side effects after discontinuation
If diclofenac has been taken briefly because of acute pain or inflammation, it can usually be stopped without any problems. Usually this does not cause any side effects. If the drug is to be discontinued after a long period of use, a doctor should be consulted. When diclofenac is taken in the context of chronic inflammatory diseases such as rheumatoid arthritis, it can only relieve symptoms and not stop or cure the disease itself. Accordingly, after stopping the drug, pain and inflammatory processes can recur, either directly or after a delay as part of a so-called rheumatic attack.
