Acetic Acid Derivatives
Diclofenac (Voltaren) is a phenylacetic acid derivative that is a potent inhibitor of COX and that has analgesic, antiinflammatory, and antipyretic effects. Its use is ac-companied by side effects similar to those of other NSAIDs. Indications for the drug include rheumatoid arthritis, osteoarthritis, and ophthalmic inflammation (use of an ophthalmic preparation).
Ketorolac (Toradol) is an NSAID with very mild an-tiinflammatory and antipyretic activity. It is a potent anal-gesic for postoperative pain. Its efficacy is equivalent to that of low doses of morphine in the control of pain. For this reason it is often combined with opioids to reduce opioid dose and related side effects while providing ade-quate pain relief. It is also used to replace the opioids in some patients with opioid sensitivity. The mechanism of action of ketorolac involves the inhibition of COX and decreased formation of prostaglandins. However, some evidence exists that ketorolac may stimulate the release of endogenous opioids as a part of its analgesic activity.
Tolmetin (Tolectin) is an antiinflammatory, anal-gesic, and antipyretic agent that produces the usual gas-tric distress and ulceration observed with NSAIDs. However, tolmetin is better tolerated than aspirin and produces less tinnitus and vertigo. Tolmetin is a substi-tute for indomethacin in indomethacin-sensitive pa-tients and is unique among such drugs in that it can be used to treat juvenile arthritis.