Introduction
Cambia (diclofenac potassium) is a nonsteroidal anti-inflammatory drug (NSAID) specifically formulated as an oral powder for solution. It is indicated for the acute treatment of migraine attacks with or without aura in adults. Unlike other NSAID formulations, Cambia is designed for rapid dissolution and absorption, making it particularly suitable for migraine treatment where rapid onset of action is desirable.
Mechanism of Action
Cambia exerts its therapeutic effects through inhibition of prostaglandin synthesis by decreasing the activity of the cyclooxygenase (COX) enzymes, primarily COX-1 and COX-2. Prostaglandins are mediators of inflammation, pain, and fever. By reducing prostaglandin production, Cambia provides analgesic, anti-inflammatory, and antipyretic effects. The specific mechanism in migraine treatment involves modulation of neurovascular inflammation and inhibition of sensitization of trigeminal nerve pathways.
Indications
- Acute treatment of migraine attacks with or without aura in adults
- Not indicated for migraine prophylaxis
Dosage and Administration
Standard dosing: 50 mg (one packet) dissolved in 1-2 ounces of water immediately before administration Administration:- Empty entire packet contents into cup
- Add 1-2 ounces of water and stir well
- Administer immediately after dissolution
- Do not administer with liquids other than water
- Do not use if solution is not clear
- Renal impairment: Use caution in patients with renal insufficiency
- Hepatic impairment: Not recommended in patients with hepatic impairment
- Elderly: Consider starting at lower end of dosing range
- Pediatrics: Safety and effectiveness not established
Pharmacokinetics
Absorption: Rapidly absorbed following oral administration; peak plasma concentrations achieved within 15-30 minutes (significantly faster than tablet formulations) Distribution: 99% protein bound; volume of distribution approximately 1.3 L/kg Metabolism: Extensive hepatic metabolism primarily via CYP2C9, with minor contributions from CYP2C8 and CYP3A4 Elimination: Terminal half-life approximately 2 hours; excreted primarily in urine (65%) and bile (35%)Contraindications
- History of hypersensitivity to diclofenac or other NSAIDs
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
- Third trimester of pregnancy
Warnings and Precautions
Cardiovascular risk: NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke GI risk: Risk of GI bleeding, ulceration, and perforation Hepatic effects: May cause serious hepatic reactions including liver failure Renal effects: May cause renal injury including acute renal failure Hypertension: New onset or worsening of existing hypertension Heart failure: Fluid retention and edema reported with NSAID useDrug Interactions
Anticoagulants: Increased risk of bleeding with warfarin ACE inhibitors/ARBs: Reduced antihypertensive effect Diuretics: Reduced diuretic effectiveness Lithium: Increased lithium levels Methotrexate: Increased methotrexate toxicity Cyclosporine: Increased nephrotoxicity SSRIs/SNRIs: Increased risk of GI bleeding Other NSAIDs: Avoid concomitant useAdverse Effects
Common (>1%): Nausea, dizziness, somnolence, dyspepsia Serious: GI bleeding, cardiovascular events, hepatic toxicity, renal impairment, anaphylactic reactions, severe skin reactionsMonitoring Parameters
- Pain relief and migraine symptoms
- Blood pressure at baseline and periodically during treatment
- Renal function in patients at risk
- Hepatic function tests with prolonged use
- Signs of GI bleeding
- Signs of cardiovascular events
Patient Education
- Use only for acute migraine attacks, not for prevention
- Dissolve completely in water immediately before use
- Do not use more than 3 packets in 24 hours
- Report signs of GI bleeding (black stools, vomiting blood)
- Report signs of allergic reactions (rash, swelling, difficulty breathing)
- Avoid alcohol during treatment
- Notify healthcare provider of all medications being taken
- Do not use during third trimester of pregnancy
- Seek immediate medical attention for chest pain, shortness of breath, or neurological symptoms
References
1. FDA Prescribing Information: Cambia (diclofenac potassium) for oral solution 2. Silberstein SD, et al. Diclofenac potassium powder for solution for the acute treatment of migraine: a randomized, double-blind, placebo-controlled study. Headache. 2011;51(2):215-224. 3. Derry S, et al. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;4:CD008783. 4. Becker WJ. Acute migraine treatment. Continuum (Minneap Minn). 2015;21(4):953-972. 5. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59(1):1-18.