Oral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis

Francio, Vinicius Tieppo; Davani, Saeid; Towery, Chris; Brown, Tony L

doi:10.1080/15360288.2017.1301616

Cited by 40 publications

(26 citation statements)

References 28 publications

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“…Diclofenac sodium is an NSAID available for oral and topical administration. However, systemic administration can lead to adverse effects [61]. Considering this, one study [29] compared the local (mouthwash) and systemic use of diclofenac, showing no significant differences between groups.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

et al. 2020

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Objectives To assess and compare the pharmacological effect of different drugs on pain relief after periodontal surgery. Materials and methods Five databases were searched up to September 2019. The eligible studies comprised randomized clinical trials, involving only adult individuals that received any periodontal surgery and presenting two distinct groups of therapeutic regimens to control postoperative pain. Placebo groups could be included. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyses were performed using different follow-up and drug comparisons. Results Overall, 2398 studies were identified, of which 35 were included. Low risk of bias was determined for the majority of the studies. The meta-analyses showed that the comparison of dexamethasone or non-steroidal anti-inflammatory drugs (NSAID) versus placebo favored the use of both interventions in a follow-up of 1 to 8 h for open flap procedures (OFP). However, no statistical difference was found for the comparison between NSAID and dexamethasone for OFP. Conclusions Patients may benefit from several pharmacological schemes for pain relief after periodontal surgeries. However, due to the high heterogeneity among studies, no fixed pharmacological protocol could be proposed. Clinical relevance There is not enough evidence to recommend one therapeutic scheme. However, untreated pain is harmful to the patients and it is not advisable.

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Section: Discussionmentioning

confidence: 99%

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

et al. 2020

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“…Topical application of diclofenac did not lead to therapeutic plasma concentrations, but measurable levels were verified in all study participants. It might well be that topical application correlates with higher local concentration in the tissue at the site of application . A strength of our study is that not only diclofenac plasma levels were measured but also target engagement indicated by reduction of thromboxane B2 during blood coagulation (serum generation) was analysed.…”

Section: Discussionmentioning

confidence: 99%

“…Oral diclofenac is known to be absorbed faster and to lead to greater systemic bioavailability than topical application . Therefore, topical diclofenac administration is frequently discussed as an alternative for patients at risk of adverse drug events, since it might have less systemic side effects . Nonetheless, some preparations of topical diclofenac have been reported to reach measurable plasma concentrations after repeated application …”

Section: Introductionmentioning

confidence: 99%

Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging†

Hellms

Gueler

Gutberlet

et al. 2019

Journal of Pharmacy and Pharmacology

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Objectives We investigated changes of renal perfusion after topical and oral diclofenac administration in healthy volunteers using functional magnetic resonance imaging (MRI) with arterial spin labelling (ASL). Methods Twenty‐four healthy human participants (21–51 years) underwent 1.5T MRI before and 1 h after a single oral dose of diclofenac (50 mg). Twelve of 24 participants underwent an additional MRI examination following 3‐day topical diclofenac administration. For renal perfusion imaging, a flow‐sensitive alternating inversion‐recovery TrueFISP ASL sequence was applied. Plasma concentrations of diclofenac and serum concentrations of thromboxane were determined. Key findings After oral diclofenac application, large interindividual differences in plasma concentrations were observed (range <3–4604 nm). Topical diclofenac application did not result in relevant systemic diclofenac levels (range 5–75 nm). MRI showed a significant reduction of renal perfusion in individuals with diclofenac levels ≥225 nm (baseline: 347 ± 7 vs diclofenac: 323 ± 8 ml/min/100 g, P < 0.01); no significant differences were observed in participants with diclofenac levels <225 nm. Diclofenac levels correlated negatively with thromboxane B2 levels pointing towards target engagement. Conclusions Single‐dose diclofenac caused a decrease in renal perfusion in participants with diclofenac levels ≥225 nm. We demonstrated that even a single dose of diclofenac can impair renal perfusion, which could be detrimental in patients with underlying chronic kidney disease or acute kidney injury.

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“…It has been used for acute or chronic treatment of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis [15]. However, like other general NSAIDs, diclofenac (DIC) sodium revealed similar gastrointestinal disorders and obvious hepatocellular toxicities [16]. Thus, to develop novel dosage forms to avoid toxicities and prolong retention time in the local area will be very promising to improve the clinical application against OA inflammation and pain control.…”

Section: Introductionmentioning

confidence: 99%

Hyaluronan-Loaded Liposomal Dexamethasone–Diclofenac Nanoparticles for Local Osteoarthritis Treatment

Chang

Chiang

Kuo

et al. 2021

IJMS

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Osteoarthritis (OA) remains one of the common degenerative joint diseases and a major cause of pain and disability in older adult individuals. Oral administration of non-steroidal anti-inflammatory drugs (NSAIDs) (such as diclofenac, DIC) or intra-articular injected gluco-corticosteroids (such as dexamethasone, DEX) were the conventional treatment strategies for OA to reduce joint pain. Current limitations for both drugs including severe adverse effects with risks of toxicity were noted. The aim of the present study was to generate a novel OA treatment formulation hyaluronic acid (HA)-Liposomal (Lipo)-DIC/DEX to combat joint pain. The formulation was prepared by constructing DIC with DEX-loaded nanostructured lipid carriers Lipo-DIC/DEX mixed with hyaluronic acid (HA) for prolonged OA application. The prepared Lipo-DIC/DEX nanoparticles revealed the size as 103.6 ± 0.3 nm on average, zeta potential as −22.3 ± 4.6 mV, the entrapment efficiency of 90.5 ± 5.6%, and the DIC and DEX content was 22.5 ± 4.1 and 2.5 ± 0.6%, respectively. Evidence indicated that HA-Lipo-DIC/DEX could reach the effective working concentration in 4 h and sustained the drug-releasing time for at least 168 h. No significant toxicities but increased cell numbers were observed when HA-Lipo-DIC/DEX co-cultured with articular chondrocytes cells. Using live-animal In vivo imaging system (IVIS), intra-articular injection of each HA-Lipo-DIC/DEX sufficed to reduce knee joint inflammation in OA mice over a time span of four weeks. Single-dose injection could reduce the inflammation volume down to 77.5 ± 5.1% from initial over that time span. Our results provided the novel drug-releasing formulation with safety and efficiency which could be a promising system for osteoarthritis pain control.

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Oral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis

Cited by 40 publications

References 28 publications

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging†

Hyaluronan-Loaded Liposomal Dexamethasone–Diclofenac Nanoparticles for Local Osteoarthritis Treatment

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