Naklofen Duo (Diclofenac Sodium)

Diclofenac sodium is indicated for several inflammatory and pain‑related conditions, acting primarily through inhibition of cyclo‑oxygenase enzymes.

• Mild to moderate pain: provides analgesic relief by reducing peripheral inflammation and sensitization.
• Osteoarthritis: decreases joint swelling and improves functional mobility in affected joints.
• Rheumatoid arthritis: helps control synovial inflammation and limits disease‑related joint damage.
• Musculoskeletal injuries: alleviates pain and swelling associated with strains, sprains and contusions.
• Ankylosing spondylitis: reduces spinal pain and stiffness, improving patient comfort and movement.

• Diclofenac sodium exerts its therapeutic effect by reversibly inhibiting cyclooxygenase‑1 (COX‑1) and cyclooxygenase‑2 (COX‑2) enzymes. This inhibition blocks the conversion of arachidonic acid to prostaglandins, thereby decreasing the synthesis of mediators that promote inflammation, pain, and fever. The reduced prostaglandin levels lead to diminished vascular permeability, leukocyte infiltration, and nociceptor sensitization at sites of tissue injury.

Adverse reactions may range from mild, self‑limiting events to serious, potentially life‑threatening conditions.

Common Side Effects

• Gastrointestinal discomfort: nausea, dyspepsia or abdominal pain.
• Headache: mild to moderate intensity, often transient.
• Dizziness or vertigo: may affect balance.
• Skin rash: localized erythema or pruritus.

Serious or Rare Side Effects

• Gastrointestinal bleeding or ulceration: can present with melena or hematemesis.
• Hepatic injury: elevated transaminases or jaundice.
• Renal impairment: reduced urine output or increased serum creatinine.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Anaphylaxis: rapid onset of respiratory distress, hypotension, and urticaria.

Before initiating therapy, clinicians should evaluate individual risk factors and monitor patients for adverse events.

• Assess gastrointestinal risk: avoid in patients with a history of ulcer disease or bleeding.
• Monitor renal function: adjust use in those with impaired kidney function or dehydration.
• Use lowest effective dose: limit duration to the shortest period necessary for symptom control.
• Avoid in known hypersensitivity: discontinue immediately if allergic reactions occur.
• Store at room temperature: keep in the original pack, protect from moisture and direct sunlight.

Diclofenac sodium can alter the pharmacokinetics or pharmacodynamics of several co‑administered agents.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): increased risk of serious bleeding.
• Selective COX‑2 inhibitors: additive cardiovascular and gastrointestinal toxicity.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may reduce renal perfusion, especially in volume‑depleted patients.
• Diuretics: heightened risk of renal dysfunction and electrolyte imbalance.
• Lithium: NSAIDs can raise serum lithium levels, requiring close monitoring.