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Is diclofenac an over the counter (OTC) for treatment of arthritis has been approved. In recent years, diclofenac has been associated online pharmacy in new zealand with an increased risk of development kidney stones. The incidence of nonhepatic (kidney) stone formation is associated with long-term use of medications that inhibit collagen deposition. The purpose of this review is to summarize the evidence on role of diclofenac in the development kidney stones, with a focus on the mechanism by which diclofenac decreases collagen deposition and to discuss its use in the management of osteoarthritis. INTRODUCTION The role of diclofenac in management arthritic diseases is complex. Several studies have examined the potential for use of OTC products containing diclofenac to affect the long-term maintenance of bone health. A 2009 meta-analysis reported decreased risk of bone loss for patients treated with diclofenac over an average of 7 years.3 The risk bone loss was decreased in patients with chronic low-grade renal insufficiency (ie, less than 6 months of renal function).3 However, the findings may be confounded by the risk of stone formation associated with diclofenac therapy,4 which is estimated to be 10.7 of 1,000 cases.5 It has been estimated that the probability of developing a nonhepatic (kidney) stone with diclofenac is between 1/200 and 1/3,7 depending on the drug used.3,6 It is unknown whether patients taking medications that inhibit collagen deposition might have a decreased risk of developing kidney stones. Although kidney stones were a large population-based issue in the United States early 1900s,3,6 number of kidney stones caused by nonhepatic (kidney) has decreased throughout the world.12 In fact, no deaths or hospitalizations due to renal stones have been reported in the literature since 1999.2 However, nonhepatic (kidney) stones could still occur in patients on diclofenac. A recent report of patient with diclofenac over the counter australia kidney stones receiving diclofenac treatment reported that the urine concentration of clofazimine was 1150 ng/mL.13 Additionally, the patient was taking warfarin for treatment of severe bleeding. This suggests that patients taking warfarin have a high risk of stones. Diclofenac 100mg $69.54 - $0.39 Per pill Therefore, the use diclofenac to prevent stones should be carefully considered. To minimize the risk of stones, clinicians may consider the following alternatives to diclofenac use:1 Use of a non-hepatic (kidney) stone-preventing medication. For some patients, the use of clofazimine, an anticoagulant, or a calcium- magnesium-binding drug, such as warfarin, is not a viable option. Furthermore, the antiplatelet medications used for treatment of clopidogrel or rivaroxaban are not indicated for the prevention of renal stones. It is important that the duration of therapy be prolonged and that the medication be taken at a dose consistent with that provided for blood thinning or the prevention of arterial thrombosis. Use of a non-hepatic (kidney) stone-preventing medication. For some patients, the use of clofazimine, an anticoagulant, or a calcium- magnesium-binding drug, such as warfarin, is not a viable option. Furthermore, the antiplatelet medications used for treatment of clopidogrel or rivaroxaban are not indicated for the prevention of renal stones. It is important that the duration of therapy be prolonged and that the medication be taken at a dose consistent with that provided for blood thinning or the prevention of arterial thrombosis. Consideration the use of an anti-inflammatory drug to reduce the risk of urinary tract infection (UTI) or recurrent urinary tract infections (RUTIs). The use of diclofenac alone cannot prevent UTIs or RUTIs. The risk of developing a recurrent UTI (RUTI) is 1 in every 800–1,000 patients on this anti-inflammatory drug. The RUTI rate for those treated with dibenfluramine alone is 1 in 5,000, and if dibenfluramine is not the only therapeutic agent and is not taken in the correct ratio, risk of developing a RUTI increases.14 Other nonhepatic (kidney) stone therapies like corticosteroids and cyclosporine have not been associated with a benefit in preventing kidney stones.15 Adoption of the following methods can reduce risk of stone formation and its progression to kidney stones:15

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