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Razvoj lijeka manjom renalnom ekskrecijom, kao što su acemetacin, di-
klofenak i etodolak .
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Uprkos širokoj kliničkoj upotrebi, diklofenak je lijek koji
ima značajan potencijal unapređenja primjene i mogućnosti Uz ranije navedene strategije smanjenja nuspojava,
poboljšanja. To se prvenstveno odnosi na rijetke, ali potenci- istražuje se nekoliko strukturnih modifikacija lijeka 32, 33 . Za-
jalno teške nuspojave poput gastrointestinalnog krvarenja, mjena hidroksilnih (OH) radikala u COOH novim radikalima
nastanka ulkusa, perforacije, enteropatije, kardiovaskular- (CH , OCH , CH NH , NH , NHCOCH , NHCONH , Cl, CF ) u
3
2
2
3
2
2
3
3
nih problema, inhibicije trombocita, toksičnosti na bubrege, računskim kalkulacijama i pretkliničkim studijama predviđa
jetru i neurotoksičnost. Nekoliko novijih studija istraživalo manje gastrointestinalnih nuspojava uz bolje farmakokine-
je razloge toksičnosti NSAID. Potvrđeno je da bi defektan tičke osobine novih analoga diklofenaka . Selektivna inhi-
32
metabolički enzim CYPC19 mogao biti odgovoran za toksič- bicija COX-2 postiže se supresijom NF-κB/NLRP3 signalnog
nost diklofenaka kod osjetljivih ljudi . Za sve NSAID koji su puta uz smanjenje intestinalnih nuspojava 33, 34 .
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rastvorljivi u vodi toksičnost je veća kod osoba koje imaju
manji procenat vode u organizmu, a manja je kod lijekova s
Zaključak
Diklofenak je potvrđeno uspješan u liječenju akutnog muskuloskeletnog i postoperativnog bola, s
jakim antiinflamatornim, analgetskim i antipiretskim djelovanjem. Niz formulacija lijeka omogućava
njegovu terapijsku primjenu peroralno, intravenski, intramuskularno ili lokalno, nanošenjem na
kožu i sluznice. Tipične su kombinacije lijeka sa tramadolom i paracetamolom. Njima se postiže
bolji analgetski efekat, dok se kombinacijom sa inhibitorima protonske pumpe smanjuju gastrične

tegobe. Kao i svi drugi NSAID, dovodi do inhibicije COX-2 enzima, što kod rizičnih grupa pacijenata
može povećati rizik organskih komplikacija.

Abstract

Diclofenac is a non-steroidal anti-inflammatory drug, which has been on the market for many years. During its clinical
use, it has been confirmed as an effective analgesic for the treatment of acute post-traumatic pain, postoperative pain,
and chronic pain conditions such as chronic back pain and rheumatoid arthritis. In addition to its analgesic effects, it
has also been confirmed as an anti-inflammatory drug and antipyretic. Diclofenac is available on the market in various
formulations that allow for its systemic use intravenously, intramuscularly, orally, rectally, or topically on the skin and
mucous membranes. This review article aims to present the main methods of diclofenac administration and the results of
some studies comparing its efficacy with other non-steroidal anti-inflammatory drugs. The most common side effects and
strategies for avoiding them are also presented.

Keywords: non-steroidal anti-inflammatory drugs, diclofenac, analgesia, acute pain, chronic pain, drug formulation, side
effects

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REVIJALNI RADOVI Galenika Medical Journal, 2024; 3(11):36-40. 39