Any of you who have ever taken of our safe opiate prescribing compliance courses know that I’m a huge fan of combination drugs – like Advil Dual Action. The reason is compliance – one of the worst practices is to give a patient 5 or 6 prescriptions after a procedure – the likelihood a patient will follow through with instructions is inversely related to the number of prescriptions given and the frequency of administration. And then we wonder why our patients aren’t compliant, right? So, ideally it’s best to use drugs that are 1) safe 2) effective 3) have a long half-life and 4) combine drugs when possible.
I was intrigued to learn about Arthrotec. I kinda hate to say that because it’s been around for…well…decades.
Better late than never, right?
Arthrotec is a combination of the NSAID diclofenac and the cytoprotective agent misoprostol which is approved for arthritic conditions. The logic behind the combination is that those with arthridities treated with an NSAID are far more likely long term to develop GI ulceration with possible bleeding. And so the cytoprotective agent in combination with an NSAID is shown to be clinically effective in preventing adverse GI sequelae.
However, there’s a twist to Arthotec. A growing body of evidence supports the view that the diclofenac/misoprostol combination provides an improved therapeutic ratio over diclofenac alone, not only by improving gastrointestinal safety but also by enhancing analgesic/antiinflammatory effects. When using an oral surgery pain model, the combination of diclofenac/misprostol improves pain relief over diclofenac alone and for longer duration. In other words, this is a true example of pharmacologic synergism.
A growing body of evidence supports the view that the diclofenac/misoprostol combination provides an improved therapeutic ratio over diclofenac alone, not only by improving gastrointestinal safety but also by enhancing analgesic/antiinflammatory effects.Diclofenac/Misoprostol: novel findings and their clinical potential.
J Rheumatol Suppl. 1998 May;51:31-41
Another earlier study from Temple University looked at the combination of ibuprofen/misprostol with equivocal results but also noted improved therapeutics with diclofenac/misoprostol. So, apparently the combination of diclofenac/misoprostol is unique.
This product might be considered in patients with a history of GI disorders and possibly in combination with acetaminophen. High dose acetaminophen has also been demonstrated to be an excellent analgesic in an oral surgery pain model and Arthrotec might be a useful alternative to an opiate for control of breakthrough pain.