diflunisal

Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) in the salicylate class. It is a derivative of salicylic acid and is used to relieve pain and inflammation in a variety of conditions. It has been marketed under the brand name Dolobid and is one of the longer-acting NSAIDs.

Medical uses and indications include relief of mild to moderate pain and anti-inflammatory management for conditions such as osteoarthritis, rheumatoid arthritis, dental pain, and postoperative pain. As with other NSAIDs, it is chosen for its combination of analgesic and anti-inflammatory effects, but its use is weighed against potential gastrointestinal and cardiovascular risks.

Diflunisal works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which decreases the synthesis of prostaglandins involved in pain and inflammation. This mechanism underlies its analgesic, anti-inflammatory, and antipyretic effects.

Pharmacokinetics and administration are typically via oral dosing. Diflunisal is well absorbed and exhibits high protein binding. It is primarily metabolized in the liver and excreted by the kidneys, with a duration of action longer than some other NSAIDs, allowing for less frequent dosing.

Adverse effects and safety considerations include gastrointestinal irritation, dyspepsia, gastritis, ulcers, and an increased risk of GI bleeding. Other risks include renal impairment, hypertension, edema, and hypersensitivity reactions. Diflunisal is contraindicated in individuals with known NSAID or salicylate allergy, active peptic ulcer disease, significant kidney disease, or known bleeding disorders. It should be used with caution in the elderly and in those taking anticoagulants or other NSAIDs. Safety in children is limited, and salicylates carry a known risk of Reye’s syndrome in young patients. Pregnancy, especially in later trimesters, is generally discouraged.