Diclofenac Sodium vs. Arthrotec

Diclofenac sodium and Arthrotec are medicines used to relieve pain.

Diclofenac sodium is a non-steroidal anti-inflammatory drug (NSAID). In addition to relieving pain, NSAIDs also relieve inflammation and are particularly useful for arthritic diseases such as rheumatoid arthritis and severe forms of osteoarthritis. They are also used to relieve back pain; sprains; dental pain; and dysmenorrhoea, painful menstruation, and to reduce the temperature in a fever.

Arthrotec is a combination of diclofenac sodium and misoprostol, a synthetic compound that offers protection from the damaging gastric side effects of diclofenac sodium. The combination of diclofenac and misoprostol is designed to provide the pain-relieving effects of NSAIDs while protecting against the potential for gastric and duodenal ulceration.

Effects

• Protaglandins protect the intestines from stomach acids.

  In certain diseases or after injury and surgery, the body produces chemicals called prostaglandins that cause inflammation, pain and swelling. NSAIDs work by blocking the production of prostaglandins. Prostaglandins also reduce acids in the stomach and protect the intestines from excess acids by producing alkaline bicarbonate and increasing mucus. An unwanted side effect of diclofenac sodium and other NSAIDs is the potential for gastric or duodenal ulceration because the protective action of the prostaglandins has been suppressed.

Arthrotec

• Arthrotec provides pain relief and protects the stomach.

  Arthrotec is a combination of diclofenac and misporotol, a synthetic compound with similar effects to the prostaglandins made in the stomach and intestines. Arthrotec was the first combination drug to offer both pain relief and gastric protection and was approved by the U.S. Food and Drug Administration in December 1997.

Warning

• Misoprostol must never be taken in pregnancy.

  Arthrotec is a combination of drugs and therefore has the potential of causing the unwanted side effects of both. Drugs.com lists the potential unwanted effects of diclofenac, including gastric and duodenal ulceration and perforation. There is a small increased risk of heart and circulatory problems, including heart attack and stroke.

  Misoprostol can cause shivering and fever, abdominal pain, nausea and diarrhea. Used in obstetrics it induces labor and will induce termination of pregnancy if taken during the first trimester. It may also cause fetal abnormalities and crosses into breast milk.

Significance

• Drugs.com lists significantly more unwanted effects for the combined drug than for each drug individually. In 1999 In a memo to Searle Parmaceuticals, manufacturer of Arthrotec, the FDA warned against presenting its new drug purely as an NSAID because of the specific risks associated with misoprostol. The FDA also warned against any claims that implied that Arthrotec was safer or had fewer side effects as opposed to NSAIDs alone.

Benefits

• All medicines and drugs have unwanted side effects, and the rationale for using any medicine is that the benefits must outweigh any risks. Arthrotec has several potentially serious or even life-threatening unwanted effects, but it is also used successfully to relieve pain in patients with arthritic diseases. It is only available by prescription after consultation with a doctor. Both doctor and patient must make full and honest disclosure, and all potential interactions with other medications and all potential side effects should be discussed. The drug must be taken exactly as prescribed, and the patient should report any adverse effects.