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Diclofenac sodium has been shown to be effective and well tolerated in a number of open and double-blind studies. It has similar efficacy to indomethacin, but is generally better tolerated. Typical doses were 75 - 150 mg daily in divided doses or 100 mg of the retard preparation once daily occasionally supplemented with 25 - 50 mg of the standard tablet.

Suppositories administered at night were often helpful in the elderly or in other patients prone to upper gastrointestinal symptoms such as heartburn.

Osteoarthritis

Diclofenac sodium can often be used in lower doses in osteoarthritis as compared with rheumatoid arthritis, and in clinical trials it is also well tolerated and effective. In a long-term study 50% of patients treated with diclofenac achieved a 'good' or 'very-good' status over a 3 - 6 month period and the preparation was superior to indomethacin in this group of patients.

Low Back Pain, Injuries and Manifestations of Soft Tissue Rheumatism

Studies have indicated that diclofenac is effective in various manifestations of soft tissue rheumatism including low back pain. Piroxicam and diclofenac were compared in 310 patients with a variety of musculoskeletal injuries with no statistically different response, both preparations having an equally rapid and effective onset of drug action.

Ankylosing Spondylitis

In a large number of noncomparative studies diclofenac 100 - 150 mg in divided doses daily or as suppositories has produced good to excellent response in 60 - 80% of patients with ankylosing spondylitis as has the 100 mg retard form given in the morning. A small number of double-blind studies have shown diclofenac is at least as effective as indomethacin.

Oral administration of 150 mg daily was as effective as indomethacin 150 mg daily.

Control of Pain and Inflammation in Orthopaedic, Dental and other Minor Surgery

In oral doses of 50 - 100 mg daily it has been found to be an effective analgesic for dental and minor surgical pain.

Diclofenac Sodium has been compared with aspirin in juvenile rheumatoid arthritis and found to be equally effective and clearly superior to placebo. No adverse effects were recorded in the diclofenac group whereas one third of patients on acetylsalicylic acid discontinued because of adverse effects.

Postoperative Pain

Studies of postoperative pain relief performed with diclofenac daily following partial menisectomy using both oral and intramuscular dosage forms. It was as effective as pethidine in the 6 hours following administration but less so at 24 hours.

After abdominal surgery diclofenac intramuscularly had significant morphine-sparing effects.

Diclofenac is at least as effective as usual therapeutic doses of NSAIDs and narcotic analgesics such as oxycodone, dihydrocodeine plus paracetamol, pentazocine and pethidine but was devoid of the CNS effects associated with narcotics. Also the onset of analgesia was frequently more rapid with diclofenac.

Renal Colic

Prostaglandin synthetase inhibition with Diclofenac Sodium has been used in the management of renal colic where ureteric obstruction caused increased synthesis and release of prostaglandins. In one study Diclofenac Sodium 75 mg intramuscularly was found to be more effective than 100 mg pethidine in the management of renal colic with fewer side effects.