Diclofenac up2date – Teil 2: Einsatz bei speziellen Patientengruppen

Zusammenfassung

Das Nicht-Opioid-Analgetikum Diclofenac wird weltweit zur Therapie muskuloskelettaler und perioperativer Schmerzen eingesetzt. Nicht zuletzt wegen der freien Verfügbarkeit niedrigdosierter Präparate als “over-the-counter“-Medikament müssen renale, gastrointestinale und kardiale unerwünschte Wirkungen berücksichtigt werden. Die Vielzahl der verfügbaren Applikationsformen (u.a. Tabletten, Zäpfchen, Tropfen, Gele, Pflaster) mit ihren jeweils spezifischen zugelassenen Indikationen, Dosierungsempfehlungen und Anwendungsbeschränkungen kann verwirrend sein und sowohl einen inadäquaten Einsatz als auch die Vorenthaltung eines potenten Analgetikums bedingen. Die vorliegende Übersichtsarbeit soll Anästhesisten, Schmerztherapeuten und Intensivmedizinern die wichtigsten Aspekte dieser weit verbreiteten Substanz für den Einsatz bei bestimmten Krankheitsbildern und Patientengruppen präsentieren.

Abstract

The non-opioid analgesic diclofenac is used worldwide for musculoskeletal and perioperative pain therapy. Despite its frequent use and easy access as an “over the counter” drug, gastrointestinal, cardiovascular, and renal adverse drug effects have to be considered. Availability of diverse formulations (e.g. tablets, suppository, gel-formulations) with different indications, dosage recommendations and contraindications may easily lead to confusion, thus accounting for inadequate use on the one hand or withholding of an effective analgesic. This review may provide physicians in perioperative medicine, intensive care and pain therapy with important and suitable information about the pharmacology and appropriate use of this drug.

Kernaussagen

• Diclofenac sollte bei Schwangeren im 3. Trimenon und bei Säuglingen nicht verwendet werden.

• Der Einsatz von Diclofenac bei Kindern < 14 Jahre erfolgt überwiegend „off-label“, ist aber vermutlich sicher (bei unsicherer Datenlage zur optimalen Dosis).

• Topisches Diclofenac ist bei Patienten mit Hand- oder Kniearthrose ebenso wirksam wie systemisches, weist aber eine geringere Rate an unerwünschten Arzneimittelwirkungen auf.

Schlüsselwörter:

Diclofenac - Nicht-Opioid-Analgetikum - Schmerztherapie

Keywords:

Diclofenac - drug - pain therapy - non-opioid analgesic

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