Eniva Vitamins, Minerals, Electrolyte Water, and Nutiritional Supplements Diclofenac

Interactions with Dietary Supplements

Calcium
Diclofenac decreases the amount of calcium lost in the urine,¹ which may help prevent bone loss in postmenopausal women.²

L-tryptophan
Diclofenac causes complex changes to L-tryptophan levels in the blood,³ but the clinical implications of this are unknown. More research is needed to determine whether supplementation with L-tryptophan is a good idea for people taking diclofenac.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression. Diclofenac may inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral.⁴ Since minor changes in lithium blood levels can produce unwanted side effects, diclofenac should be used with caution in people taking lithium supplements.

Interactions with Herbs

Stinging nettle (Urtica dioica)
In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.⁵ More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.

Willow (Salix alba)
Willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of aspirin to individuals taking diclofenac results in a significant reduction in blood levels of diclofenac.⁶ Though there are no studies investigating interactions between willow bark and diclofenac, people taking the drug should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Taking diclofenac with food may lower the maximum concentration of the drug in the blood and may delay, but not decrease, absorption.⁷ NSAIDs such as diclofenac should be taken with a meal to reduce stomach irritation.

Smoking
Injury to the stomach caused by NSAIDs such as diclofenac can resolve naturally despite continued administration of the drug. However, the stomach lining of smokers is less likely to adapt to injury, leading to continued damage from the drug.⁸

Alcohol
Chronic consumption of alcohol can aggravate injury to the stomach and duodenal lining caused by diclofenac.⁹ To prevent added injury, consumption of alcoholic beverages should be avoided in individuals taking diclofenac.

Depletion or interference	Calcium Lithium L-tryptophan*
Adverse interaction	None known
Side effect reduction/prevention	None known
Supportive interaction	Stinging nettle
Reduced drug absorption/bioavailability	Willow*

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Sharma S, Vaidyanathan S, Thind SK, et al. The effect of diclofenac sodium on urinary concentration of calcium, uric acid and glycosaminoglycans in traumatic paraplegics. Br J Urol 1991;68:240–2.

2. Bell NH, Hollis BW, Shary JR, et al. Diclofenac sodium inhibits bone resorption in postmenopausal women. Am J Med 1994;96:349–53.

3. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

4. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

5. Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105–8.

6. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

7. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

8. Lipscomb GR, Campbell F, Rees WD. The influence of age, gender, Heliobacter pylori and smoking on gastric mucosal adaptation to non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 1997;11:907–12.

9. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2889–91.

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The information presented in VitaminLore is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.