DICLOFENAC: UPDATE ON TOLERABLENESS AND SPINAL ANTI-INFLAMMATORY ACTION

The non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs in the control of postoperative pain. In choosing the NSAID to be used, it is essential to assess the most favorable risk/benefit ratio according to a careful assessment of intrinsic and extrinsic risk factors and cardiovascular, gastrointestinal, renal and metabolic patient comorbidities. Diclofenac dose of 150 mg/die is the NSAID that has wider literature that attests its efficacy and tolerability. Due to its high lipid solubility, it is one of the few NSAIDs that are able to cross the blood-brain barrier, with an action principally directed towards COX-2. Over time, several studies have been conducted to evaluate the side effects of NSAIDs. Regarding Diclofenac's cardiovascular and gastrointestinal tolerability, recent studies indicate that the relative risk and absolute risk of complications of Diclofenac are similar to COXIB and inferior to other NSAIDs. Important feature of Diclofenac is that, unlike other NSAIDs, it does not interfere with the cardio-protective effect of acetyl-salicylic acid. Diclofenac potassium is instead indicated for use as an analgesic in headache and as an antipyretic in influenza-like symptoms. Studies with the aim of investigating the intestinal damage exacerbated by proton pump inhibitors drugs, when associated with NSAIDs, state that at least in part, they aggravate the intestinal damage induced by NSAIDs due to significant changes in intestinal microbial populations. The reference dose of Diclofenac used in all randomized controlled trials is 150 mg/die; this controlled release dosage allows to decrease the number of daily administrations, ensuring a better patient compliance, especially if elderly and/or in polytherapy.