Diclofenac induced acute renal failure in a decompensated elderly patient

Dhanvijay, Pallavi; Misra, Arup Kumar; Varma, Sushil Kumar

doi:10.4103/0976-500x.110916

Cited by 38 publications

(36 citation statements)

References 9 publications

(18 reference statements)

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“…33 Conventionally prescribed diclofenac formulation has also been reported to be more commonly associated with hepatotoxicity, gastrointestinal toxicity, and renal toxicity, especially during prolonged administration. [34][35][36] Inflammatory pain involved complex mechanisms that, in general, are defined as a combination of spontaneous pain and hyperalgesia. The hyperalgesic response or enhanced sensitivity to pain after an inflammatory stimulus is characterized by a peripheral sensitization of nociceptors and nociceptive neurons through alteration in nervous system plasticity to inflammatory mediators released.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of antinociceptive activity of nanoliposome-encapsulated and free-form diclofenac in rats and mice

Goh

Tang

Chiong

et al. 2014

IJN

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Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, antinociceptive, and antipyretic activities. Liposomes have been shown to improve the therapeutic efficacy of encapsulated drugs. The present study was conducted to compare the antinociceptive properties between liposome-encapsulated and free-form diclofenac in vivo via different nociceptive assay models. Liposome-encapsulated diclofenac was prepared using the commercialized proliposome method. Antinociceptive effects of liposome-encapsulated and free-form diclofenac were evaluated using formalin test, acetic acid-induced abdominal writhing test, Randall–Selitto paw pressure test, and plantar test. The results of the writhing test showed a significant reduction of abdominal constriction in all treatment groups in a dose-dependent manner. The 20 mg/kg liposome-encapsulated diclofenac demonstrated the highest antinociceptive effect at 78.97% compared with 55.89% in the free-form group at equivalent dosage. Both liposome-encapsulated and free-form diclofenac produced significant results in the late phase of formalin assay at a dose of 20 mg/kg, with antinociception percentages of 78.84% and 60.71%, respectively. Significant results of antinociception were also observed in both hyperalgesia assays. For Randall–Sellito assay, the highest antinociception effect of 71.38% was achieved with 20 mg/kg liposome-encapsulated diclofenac, while the lowest antinociceptive effect of 17.32% was recorded with 0 mg/kg liposome formulation, whereas in the plantar test, the highest antinociceptive effect was achieved at 56.7% with 20 mg/kg liposome-encapsulated diclofenac, and the lowest effect was shown with 0 mg/kg liposome formulation of 8.89%. The present study suggests that liposome-encapsulated diclofenac exhibits higher antinociceptive efficacy in a dose-dependent manner in comparison with free-form diclofenac.

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Section: Discussionmentioning

confidence: 99%

Evaluation of antinociceptive activity of nanoliposome-encapsulated and free-form diclofenac in rats and mice

Goh

Tang

Chiong

et al. 2014

IJN

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“…As a result of the drug's inhibitory effect on cyclooxygenase, it inhibits prostaglandins biosynthesis from arachidonic acid . Prostaglandins play a role in maintaining GFR, and this is especially critical for the maintenance of GFR in volume depleted states (Dhanvijay et al, 2013). The drug is efficiently absorbed from the gastrointestinal tract and has a short elimination half-life of 2 -3 hours in most species including humans, with an average of 1.5 hours in plasma but accumulates at the site of inflammation and tends to persist in synovial fluid (El-Maddawy and ElAshmawy, 2013).…”

Section: Introductionmentioning

confidence: 99%

Haematological and biochemical studies on the effect of diclofenac sodium on Wistar <i>Rattus norvegicus</i>

Orinya¹,

Adenkola²,

Ogbe³

2017

Int. J. Bio. Chem. Sci

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Diclofenac sodium is a non-steroidal anti-inflammatory drug commonly used worldwide for the treatment of inflammation and pain due to arthritis or other ailments in man and animals. Despite these benefits, there are concerns that this drug may have adverse effect on animal's liver and kidneys. This work was designed to determine the effect of diclofenac sodium on blood components using haematological tests, as well as determine the hepatotoxic and nephrotoxic effects using biochemical assays. Twenty rats were randomly divided into four groups with 5 rats per group. The groups 2, 3, and 4 were assigned rats, intramuscularly administered diclofenac sodium at the doses of 49.05, 98.10 and 147.15 mg/kg body weight respectively, once a day for seven days while group 1 rats were given distilled water only, and served as control. The blood collected was tested by haemoanalyzer while the serum was assayed by biochemistry analyzer. The various doses of diclofenac sodium produced significant (p<0.05) decrease in the values of haemoglobin concentration, packed cell volume, red blood cells and white blood cells while there was significant (p<0.05) increase in the levels of serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, urea, creatinine, total cholesterol, triglycerides and electrolytes. However, there was significant (p<0.05) decrease in the levels of serum total protein, albumin, glucose and HDLcholesterol. The results therefore showed that diclofenac sodium may have deleterious effect on animal tissues, resulting in hepatic and renal impairments at the given doses and treatment duration. So caution needs to be exercised in its administration, which should be limited to the lowest therapeutic doses, to prevent its harmful effect.

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“…NSAID alone causes about 15% of all cases of drug induced nephrotoxicity or 1 -5% of all NSAID users (23,24). In a case report, a geriatric patient with decompensated heart failure received oral diclofenac 25 mg/day resulted in nephrotoxicity (25). A study assessed pain control using oral ibuprofen and acetaminophen in patients after wisdom teeth extraction did not report incidents of AKI after 48-hour use (26).…”

Section: Discussionmentioning

confidence: 99%

Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

Zhu

Wang

et al. 2018

J Pharm Pharm Sci

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-Purpose:The objective of this study was to determine: 1) the incidence and the risk factors of diclofenac/acetaminophen combination as a single agent induced Acute Kidney Injury (AKI) in postoperative pain relief 2) the average cost and length of hospital stay for patients in AKI group and non-AKI group. Methods: All patients with no prior history of chronic kidney disease (CKD) and normal serum creatinine [44~130 μmol /l] who received diclofenac and acetaminophen combination as a single agent intramuscularly (IM) between January and December 2015 in The Second Xiangya Hospital, Changsha, Hunan, China were included in this retrospective own-control study. Baseline serum creatinine (SCr) and SCr during NSAID use were collected. AKI is defined as an increased of Scr over 1.5 times the baseline. Multivariate analyses were performed with a logistic regression model to assess the significant risk factors of AKI. Results: A total of 821 patients were included in the study with 63 [7.7%] patients had diclofenac/acetaminophen combination single agent induced AKI. Multivariate analysis confirmed that using diclofenac/acetaminophen combination after surgeries within 24 h were significantly associated with AKI [odds ratio, OR, 2.173; 95% CI, 1.113-4.243; P=0.023]. The average cost and length of hospitalization in AKI group was 1.87 times [p=0.000] and 1.2 times [p=0.043] comparison than non-AKI group, respectively. Conclusions: The incidence of diclofenac/acetaminophen combination single agent induced AKI in postoperative pain relief was 7.7%. Patients with hypertension or liver cirrhosis was more likely to develop AKI and using diclofenac/acetaminophen combination after surgeries within 24 h was significant risk factors for AKI. AKI prolonged the cost and length of hospitalization.

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Diclofenac induced acute renal failure in a decompensated elderly patient

Cited by 38 publications

References 9 publications

Evaluation of antinociceptive activity of nanoliposome-encapsulated and free-form diclofenac in rats and mice

Evaluation of antinociceptive activity of nanoliposome-encapsulated and free-form diclofenac in rats and mice

Haematological and biochemical studies on the effect of diclofenac sodium on Wistar <i>Rattus norvegicus</i>

Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

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