Pain and inflammation – a typical area of ​​application for the active ingredient diclofenac. That is why Diclofenac helps especially with chronic joint diseases such as rheumatism or sports injuries such as  strains  and bruises. Compared to  acetylsalicylic acid  and  paracetamol  , the active ingredient diclofenac is one of the more recent drugs: diclofenac has been on the market since 1974. The acetic acid derivative is one of the most commonly used painkillers – in Germany, manufacturers with the active ingredient diclofenac turn over around 130 million euros every year.

Effect of diclofenac

Diclofenac belongs to the group of so-called cyclooxygenase inhibitors (non-opioid analgesics), i.e. painkillers that are not opiate derivatives. Since diclofenac has a very good anti-inflammatory (antiphlogistic) effect, it is – like ibuprofen – also classified as a non-steroidal anti-inflammatory drug, i.e. an anti-inflammatory agent that does not contain steroids such as  cortisone  . Since such agents work particularly well in rheumatic diseases, they are also referred to as non-steroidal anti-inflammatory drugs (NSAIDs).

Active ingredient in painkillers

The active ingredient diclofenac is used internally and externally for the treatment of mild to moderate acute and chronic pain – especially if it is caused by inflammation or accompanied by fever. Clinical pictures for which the active ingredient is often prescribed are:

  • rheumatic diseases  such as chronic polyarthritis or arthrosis
  • acute gout attacks
  • Joint injuries during sports
  • Pain and swelling after surgery
  • Herniated discs  or
  • menstrual pain

The effect begins quite quickly – about 30 to 60 minutes after ingestion – and lasts about four hours (about twelve hours for the prolonged-release tablets, which release the active ingredient diclofenac more slowly).

How does diclofenac work?

Diclofenac inhibits the body’s own cyclooxygenases Cox-1 and Cox-2:

  • Cox-2 in particular is activated when cells are damaged and boosts the production of prostaglandins that promote inflammation and increase pain. The desired effect of diclofenac is based primarily on its inhibition.
  • Cox-1, on the other hand, increases the production of prostacyclin, which protects the gastric mucosa. Hence the stomach damaging side effects of diclofenac.

Dosage of Diclofenac

The active ingredient diclofenac – mainly known as Voltaren® – is commercially available in various dosage forms:

  • for internal use as tablets, capsules, coated tablets and drops, as well as suppositories or solution for injection
  • for external use as an ointment, gel or plaster and as eye drops

All preparations are only available in pharmacies in Germany, and depending on the amount of active ingredient and dosage form they contain, they also require a prescription.

The  maximum daily dose  for tablets is 150 mg, which is divided into three to four individual doses for normal tablets and two individual doses for sustained-release preparations.

Diclofenac side effects

The main side effects of Diclofenac are gastrointestinal problems: loss of appetite,  diarrhea , nausea, stomach pain; the risk of stomach ulcers and stomach bleeding up to a gastrointestinal perforation is increased. In patients with a corresponding sensitivity, diclofenac is always given together with a gastric protective preparation because of these side effects.

Rarer side effects are impaired kidney function, increased blood pressure and an increased tendency to bleed.

Diclofenac can also damage the liver as a side effect, especially if potentially liver-damaging substances (e.g. anticonvulsants) are taken at the same time or alcohol is abused. Rarely, one form of the side effects of diclofenac is spasm of the airways with shortness of breath.

Does diclofenac increase the risk of heart attack?

A few years ago, newer NSAIDs that specifically inhibit Cox-2 (Coxibe) were withdrawn from the market because they increase the risk of a  heart attack  . As a result, the “old” non-selective NSAIDs such as diclofenac and ibuprofen were also analyzed – and this connection can also be demonstrated here. Since then, research has been carried out on this topic – so far without conclusive results, especially since there are no satisfactory treatment alternatives for many diseases.

However, Danish researchers have found that diclofenac increases the risk of heart attack,  heart failure  or stroke. The risk of serious cardiovascular events was particularly high in people with  diabetes  or heart failure and in people who had already had a heart attack. The researchers therefore recommend carefully considering the application and classifying diclofenac as prescription-only in the future.

Important information about the active ingredient Diclofenac

When using Diclofenac, please note the following:

  • Always take the lowest possible dose of diclofenac; Discuss dosage with a doctor.
  • Do not exceed recommended maximum amount of diclofenac.
  • Do not combine diclofenac with other NSAIDs such as ibuprofen as their side effects may increase.
  • If you take Diclofenac for a long time, have your blood pressure, kidney and liver values ​​checked regularly.
  • Children and adolescents, asthmatics and pregnant women should not take diclofenac.


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