Diclofenac, topical

Darunavir (TMC114) Prezista 300 mg tablet Dexamethasone, erythromycins, voriconazole, itrraconazole, ketoconazole, aspirin, fluconazole, NSAIDS, diclofenac topical... 

HA has been used as a hydrophihc carrier to deliver diclofenac topically for the treatment of premalignant skin lesions such as actinic keratoses (AK) (106-112) and for colon-26 adenocarcinoma (113-115). HA is the preferred carrier for transdermal delivery of diclofenac, as it has been shown to enhance the partitioning of the drug into the skin compared to other vehicles (116). Furthermore, in a clinical trial, the safety and efficacy of 3% diclofenac in 2.5% HA gel have been evaluated as a topical treatment for actinic keratosis (108). Patients treated with HA-diclofenac showed significantly lower target and cumulative lesion number scores and lesion total thickness scores compared to the placebo group. The treatment with 3.0% diclofenac in 2.5% HA gel was effective when used for 60 days and was well tolerated in patients with AK. 

However, a patient taking acenocoumarol developed a pulmonary haemorrhage associated with a very prolonged prothrombin time within 10 days of starting to take diclofenac. Another report mentions a Chinese patient taking warfarin who developed an INR of 4 within 4 days of using a 1% diclofenac topical gel for joint pain. ... 

Topical diclofenac gel applied once a day for at least 6 weeks patients complain about discomfort [4]... 

Topical non-steroidal anti-inflammatory drugs (NSAIDs) decrease pain from corneal abrasion. Available ocular NSAIDs are diclofenac 0.1%, ketorolac 0.5%, nepafenac... 

Topical diclofenac in a dimethyl sulfoxide carrier (Pennsaid) is a safe and effective treatment for OA pain. It is thought to act primarily by local inhibition of COX-2 enzymes. The product was under review by the U.S. FDA at the time of this writing. 

Diclofenac (Voltaren, Cataflam) is approved for use in rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, dysmenorrhea, and topically for the treat-... 

Notify the physician if rash occurs while using topical diclofenac... 

A 0.1% ophthalmic preparation is recommended for prevention of postoperative ophthalmic inflammation and can be used after intraocular lens implantation and strabismus surgery. A topical gel containing 3% diclofenac is effective for solar keratoses. Diclofenac in rectal suppository form can be considered for preemptive analgesia and postoperative nausea. In Europe, diclofenac is also available as an oral mouthwash and for intramuscular administration. 

A topical 3% gel formulation of the nonsteroidal anti-inflammatory drug diclofenac (Solaraze) has shown moderate effectiveness in the treatment of actinic keratoses. The mechanism of action is unknown. As with other NSAIDs, anaphylactoid reactions may occur with diclofenac, and it should be given with caution to patients with known aspirin hypersensitivity (see Chapter 36). 

Cevc, G., and G. Blume. 2001. New, highly efficient formulation of diclofenac for the topical, transdermal administration in ultradeformable drug carriers. Transfersomes. Biochim Biophys Acta 1514 191. 

Muller,M.,Mascher, H., Kikuta, C., Schafer,S.,Brunner,M., and Domer, G.,et al. (1997), Diclofenac concentrations in defined tissue layers after topical administration, Clin. Pharmacol. Therap., 62(3), 293-299. 

Animals need to be bathed with copious amounts of soap and water. If dermal decontamination is not implemented quickly, mustard will react with the skin and cannot be easily removed (Sidell et al, 1997). Sodium thiosulfate (2.5% solution) can be used dermally to neutralize mustard exposures (Garigan, 1996). Animals may also be bathed with dilute (0.5%) hypochlorite solutions (Borak and Sidell, 1992). Monitor for dermal bums. Secondary infection is common. Topical silver sulfadiazine can be applied to all bums and an Ehzabethan collar placed to decrease ingestion of the ointment and self trauma. Topically applied dexa-methasone and diclofenac reduced inflammation in a mouse model when applied within 4 h (Dachir et al, 2004). All equine and ovine patients should be inoculated with tetanus toxoid. Vaccination of other species should be determined on a case by case basis. 

A more significant side effect has been reported with topical diclofenac ophthalmic solntion. Keratolysis (corneal melting) was associated with a small nnmber of cases in high-risk patients after ophthalmic snrgery. Responsibility for this side effect has been attribnted subsequently to the vitamin E-based solnbilizer/preserva-tive in the generic formulation, which has been withdrawn from the marketplace. 

Diclofenac sodium 0.1% (Voltaren, Ciba), one of the topical ophthalmic NSAIDs derived from oral formulations. 

Assouline M, Renard G, Ame JL, David T, et al. A prospective randomized trial of topical soluble 0.1% indomethacin versus 0.1% diclofenac versus placebo for the control of pain foUowing excimer laser photorefractive keratectomy. Ophthalmic Surg Lasers 1998 29 365-374. 

Hargrave SL.Jung JC, Eini ME, et al.The possible role of the vitamin E solubUizer in topical diclofenac on matrix metalloproteinase expression in corneal melting. An analysis of postoperative keratolysis. Ophthalmology 2002 109 343-350. 

Topical NSAIDs such as diclofenac sodium 0.1% solution and ketorolac 0.5% solution have been shown to reduce pain associated with corneal abrasions and shorten the time before patients can resume normal activities.The use of topical NSAIDs also reduces the need for oral analgesics however, if pain is not adequately controlled by topical medications, patients may benefit from the use of oral analgesics such as aspirin, ibuprofen. 

During acute episodes a broad-spectrum topical prophylactic antibiotic ointment, such as 0.3% tobramycin or 0.5% moxifloxacin, protects the cornea from secondary infection while it heals. The use of a therapeutic contact lens and topical NSAIDs, such as diclofenac sodium 0.1% solution or ketorolac 0.5% solution, provide symptomatic relief. The therapeutic soft contact lens also protects the regenerating epithelium and temporarily provides epithelial stability. A cycloplegic agent, such as 5% homatropine, should be instilled to decrease ciliary spasm and pain. Oral analgesics can be prescribed as needed (see Chapter 7). The eye should be examined in 24 hours and the therapy continued until the epithelial defect is healed. 

After anterior stromal puncture, PTK, or superficial keratectomy, broad-spectrum topical prophylactic ophthalmic antibiotic drops such as 0.3% tobramycin, 0.3% ciprofloxacin, or one of the newer generation fluoroquinolones, moxifloxacin or gatifloxacin, should be instilled three to four times daily, along with a broad-spectrum antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin instilled into the conjunctival sac at bedtime. NSAIDs such as diclofenac sodium 0.1% solution... 

If topical anesthetic abuse is suspected, discontinuation is critical. A broad-spectrum topical antibiotic such as 0.5% moxifloxacin three times daily is used to protect the disrupted corneal epithelium from secondary infection as the tissue heals. Topical NSAIDs, such as 0.1% diclofenac sodium solution or 0.5% ketorolac solution, and a therapeutic soft contact lens help to reduce pain. Cycloplegic and topical steroids are indicated if an anterior chamber reaction is present.Toxic keratitis can heal without permanent vision loss within days after discontinuing the use of the anesthetic but may result in permanent scarring, vascularization, and visual loss. Surgical treatment, such as a penetrating keratoplasty, may be necessary. 

Topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as bromfenac, diclofenac, ketorolac, and nepafenac, have been advocated, but there is evidence that commercially available preparations do not appear effective in treating episcleritis. Topical flurbiprofen and ketorolac were foimd to be no more effective than placebo in treating episcleritis therefore, treatment modalities other than topical NSAIDs should be used. 

Many studies evaluated the use of topical NSAIDs in preventing CME after cataract extraction. Studies found consistent benefits in prevention of CME with administration of 0.5% ketorolac tromethamine, 0.03% flurbiprofen, and 0.1% diclofenac. A meta-analysis of 16 randomized clinical trials evaluating topical NSAIDs for prevention of CME found that NSAID use was beneficial in reducing the incidence of both angiographically evident and clinically relevant CME. 

Diclofenac sodium is the active of a variety of different topical, mainly gel, preparations. These preparations are as photosensitive as aqueous solutions, which show a 30% decrease in content after one hour. The absorption of diclofenac up to about 330 nm requires the use of compounds absorbing in the UV region from 300 to 350 nm. 

Several NSAIDs have topical preparations, for example ibuprofen (Ibugel), diclofenac (Voltarol emulgel), piroxicam (Feldene gel) and ketoprofen (Oruvail gel). The objective is to produce therapeutic local concentrations without (undesirable) systemic... 

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