Managing Osteoarthritis Pain - The Power of Diflunisal

Drug Overview:

Diflunisal is a nonsteroidal anti-inflammatory drug used for the treatment of pain associated with arthritis. Diflunisal has both antipyretic and anti-inflammatory properties similar to other NSAIDs. Mild to severe pain can be treated with Diflunisal. Diflunisal was approved by the FDA (Food and Drug Administration) in April 1982 for the management of pain and inflammation in the joints due to osteoarthritis.

How Does the Drug Diflunisal Work?

Diflunisal is an NSAID that has both anti-inflammatory and antipyretic action similar to other drugs of this group like Aspirin, Ibuprofen, etc. The drug Diflunisal acts by inhibiting prostaglandin synthesis. The release of excessive prostaglandins can result in an increase in body temperature (fever) and pain. These prostaglandin receptors are inhibited by the drug Diflunisal.

Uses:

• Mild to moderate pain due to osteoarthritis.

• Rheumatoid arthritis.

• Musculoskeletal pain.

• For management of pain after dental surgeries.

Doses

The drug Diflunisal is available in various doses in the oral tablet form. The dosage of the drug is suggested by the doctor based on the symptoms presented by the patients. Diflunisal is available in the following doses.

• 250 mg.

• 500 mg.

• 1000 mg.

The patient is started with the initial doses based on the symptoms present, and then the drug dose is gradually tapered to lower doses based on the improvement of the symptoms.

For Patients

What Is Osteoarthritis?

Osteoarthritis, or degenerative joint disease (DJD) is the most common form of arthritis. Symptoms of osteoarthritis include pain, stiffness in the joint, and swelling in the joints.

Four Stages of Osteoarthritis:

• Early stage.

• Mild arthritis.

• Moderate arthritis.

• Severe arthritis.

Learn More About Diflunisal:

When and Why to Take Diflunisal Medications?

Diflunisal medications should be taken in the exact doses and schedule as suggested by the doctor after a thorough diagnosis and examination of the clinical symptoms. Diflunisal medicine is a nonsteroidal anti-inflammatory drug that helps to relieve joint pain and stiffness due to osteoarthritis.

How Effective Is Diflunisal for the Management of Osteoarthritis?

The effectiveness of Diflunisal medications can vary from person to person depending on the severity of pain due to osteoarthritis. Based on the research studies, Diflunisal is effective in relieving symptoms due to osteoarthritides, like pain and joint stiffness. Diflunisal helps to treat pain and increase the range of motion or joint mobility.

Things to Tell the Doctor Before Starting Diflunisal:

• Inform the doctor in case of any history of cardiac conditions such as high blood pressure, high cholesterol, and diabetes.

• Inform the doctor in case of any history of gastrointestinal disorders like peptic ulcer, stomach bleeding, etc.

• Inform the doctor of any history of cardiac (heart) surgeries or any other major surgeries.

• Inform the doctor about any underlying kidney or liver disease.

• Tell the doctor about any previous history of allergies to any drug or its composition.

• Tell the doctor prior if pregnant, planning pregnancy, or breastfeeding the child.

Starting Diflunisal Medications:

Things to Do After Taking Diflunisal

• Take the medications in the exact dose and schedule as prescribed by the doctor.

• It is advisable to keep the body hydrated when under Diflunisal medication.

• Check for any adverse reactions after taking the medication. In case of any side effects are noticed, inform the doctor immediately.

• Monitor the progress in the symptoms regularly; update the doctor in the follow-up visit if improvement in the symptoms is noticed.

• Update the doctor in case of worsening symptoms.

Look Out for the Side Effects:

Diflunisal medication has the following side effects:

Common Side Effects

• Stomach upset.

• Gastrointestinal ulcers.

• Gastrointestinal bleeding.

• Shortness of breath.

• Nausea and vomiting.

• Slurring of speech.

• Allergic reactions like skin rashes, itching, urticaria, etc.

• Abdominal pain.

• Dizziness.

• Edema.

• Unwanted weight gain.

• Headaches.

• Difficulty in swallowing.

• Fatigue.

• Confusion.

Serious Side Effects

• Exfoliative dermatitis.

• Liver toxicity.

• Jaundice.

• Vision disturbances.

• Increased heart rate.

• Stiffness of neck.

• Decreased urination.

• Change in color of urine (Dark urine).

• Tinnitus (ringing sensation in the ears).

Dietary Alterations

Diflunisal does not react with any food products. It is advised not to consume alcohol when under Diflunisal medications as it can lead to stomach upset. Consuming Diflunisal medications after food helps to reduce irritation in the stomach.

What Should Be Done if a Dose is Missed?

If the dose of Diflunisal is missed, then skip the missed dose and switch to a regular dosing schedule as suggested by the doctor.

What Should Be Done in Case of Diflunisal Overdose?

In case of an overdose of the drug Diflunisal, try seeking medical attention from the poison control center. Inform the doctor immediately in case of any overdose symptoms like vomiting, breathlessness, fainting, etc, are observed.

How to Store Diflunisal?

• Diflunisal should be stored at room temperature of 20 to 25 degree Celsius.

• Store Diflunisal in an airtight container.

• Diflunisal should be stored away from light and moisture.

Avoid Self-Prescription

It is advised not to consume Diflunisal without a doctor's prescription. In case of pain in the joints and stiffness of the joint, it is advisable to visit the doctor to rule out the cause and get the management done after a thorough clinical diagnosis by the doctor.

Staying On Diflunisal:

For Doctors

Indications:

• Mild to severe pain due to osteoarthritis.

• In the case of rheumatoid arthritis.

• Swelling in the joints.

Pharmacology

Mechanism of Action

The drug Diflunisal is a prostaglandin synthesis inhibitor. The drug inhibits inflammatory mediators like prostaglandins and helps to relieve pain and inflammation due to osteoarthritis.

Pharmacodynamics

Chemical Taxonomy:

• Kingdom - Organic compounds.

• Superclass - Benzenoids.

• Class - Benzene derivatives.

• Subclass - Biphenyls and derivatives.

• Direct Parent - Biphenyls and derivatives.

Ingredients

• Active Ingredient: Diflunisal is the only active ingredient present.

Inactive Ingredients:

• Cellulose.

• Hydroxypropyl cellulose.

• Hydroxypropyl methylcellulose.’

• Magnesium stearate.

• Starch.

• Talc.

• Titanium dioxide.

• Propylene glycol.

Pharmacokinetics

Absorption

The oral bioavailability of the drug is around 80 to 100 percent after oral consumption of the drug.

Plasma Concentration

After two to three hours of oral administration of the drug, the peak plasma concentration of the drug is achieved. An average of 98 to 99 percent of the drug Diflunisal is bound to plasma proteins.

Metabolism

Almost 90 percent of the drug is metabolized in the liver by glucuronide conjugation.

Elimination

The drug Diflunisal is eliminated in the urine in two different glucuronide conjugates, which are in soluble form. No traces of Diflunisal is excreted through urine.

Toxicity

Toxicity of the drug Diflunisal can result in:

• Drowsiness.

• Hyperventilation.

• Disorientation.

• Tinnitus (ringing sensation in the years).

• Sweating.

• Coma.

• Increased heart rate.

• Diarrhea.

Half-Life

The average half-life of the drugs is around eight to twelve hours.

Warning and Precautions

• Risk of Cardiovascular Thrombotic Events: Diflunisal increases the risk of adverse CVS (Cardiovascular) events like myocardial infarctions or stroke. Diflunisal should be avoided in patients with a history of coronary artery bypass surgery or any previous cardiac surgeries.

• Gastrointestinal Risk: Diflunisal (NSAIDs) increases the risk of gastrointestinal adverse events like perforation in the intestine, gastrointestinal bleeding, or gastric ulcers. Precautions should be taken before administering Diflunisal in patients with a history of gastrointestinal disorders.

• Risk of Hypersensitivity Reactions: The drug Diflunisal can result in hypersensitivity reactions. It should be cautiously used in patients with a history of allergic reactions.

Doses and Forms

The dose of the drug is decided by the doctors based on the patient's clinical condition. The drug dose varies based on the severity of the symptoms.

• For Mild to Moderate Pain: For mild to moderate pain, Diflunisal is prescribed in the dose of 1000 milligrams initially, followed by the dose of 500 mg after every twelve hours. Follow-up doses are reduced to 500 mg after every 8 hours in a few patients based on their clinical condition.

• For Very Mild Pain: For very mild or initial pain, Diflunisal is prescribed in the dose of 500 mg initially, followed by a 250 mg dose after every eight hours.

• For Osteoarthritis and Rheumatoid Arthritis: The dose of 500 mg to 1000 mg should be given to the patient diagnosed with osteoarthritis and rheumatoid arthritis.

The dose of the drug Diflunisal should be adjusted and tapered based on the patient's response to the initial dose.

Administration of the Drug

• The drug Diflunisal is prescribed to the patient in oral tablet form based on the patient's clinical condition.

• Diflunisal is prescribed in doses of 250 mg, 500 mg, and 1000 mg based on the severity of the symptom presented by the patients.

• Diflunisal is started with an initial dose based on the patient's clinical condition and is gradually tapered (maintenance dose) to lower doses based on the improvement of the patient's condition.

Contraindications

• The drug Diflunisal is contraindicated in patients with known hypertension.

• The drug is contraindicated in patients with a history of any severe allergy to any drug (hypersensitivity reactions) and has asthma or urticaria after consuming nonsteroidal anti-inflammatory medications.

• The drug Diflunisal should be avoided in patients with a history of coronary artery bypass graft (CABG) surgery.

Drug Interactions

• Diflunisal can reduce the excretion of the drug Abacavir resulting in increased serum concentration of the drug.

• Hypoglycemic actions of Acarbose can be decreased when given in combination with Diflunisal.

• Diflunisal, when combined with Abciximab, can result in increased bleeding tendencies.

• Anti-hypertensive actions of Acebutolol are reduced by the drug Diflunisal.

• When given in combination with Aceclofenac, the therapeutic efficacy of the drug Diflunisal is decreased.

• Diflunisal, when given in combination with Acetazolamide and Acemetacin, may result in an increased risk of adverse events.

Other Specifications

Diflunisal in Pregnant Women: The safety and efficacy of Diflunisal are not proven yet. The drug Diflunisal should be avoided in pregnant women, especially in the last 20 weeks of pregnancy, as nonsteroidal anti-inflammatory drugs can result in severe cardiac disorders, kidney problems, and other abnormalities in the fetus.

Diflunisal in Breastfeeding Mothers: The drugDiflunisal should be avoided in lactating mothers as traces of the drug are present in breast milk if the drug is consumed by the lactating mothers. Diflunisal can result in severe fetal deformities if prescribed in breastfeeding mothers.

Diflunisal in Pediatric Patients: The drug's safety for use in the child patient is yet not proven in children below 12 years of age. The drug is only prescribed by the doctor in the needful dose, only if clinically indicated.

Diflunisal in Geriatric Patients: The drug Diflunisal should be used very cautiously in elderly patients with any underlying systemic disorders like kidney disease, bleeding disorders, cardiovascular disorders, etc.