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. 2017 Dec;4(1):7.
doi: 10.1007/s40800-017-0049-9.

Muscle Injury After Intramuscular Administration of Diclofenac: A Case Report Supported by Magnetic Resonance Imaging

Mareike Probst  1 , Jens-Peter Kühn  2   3 , Christiane Modeß  4 , Eberhard Scheuch  4 , Anne Seidlitz  5 , Norbert Hosten  2 , Werner Siegmund  4 , Werner Weitschies  5
Affiliations

Muscle Injury After Intramuscular Administration of Diclofenac: A Case Report Supported by Magnetic Resonance Imaging

Mareike Probst et al. Drug Saf Case Rep. 2017 Dec.

Abstract

Intramuscular injection of diclofenac is still frequently practiced, although there is ample evidence that the risk of local tissue intolerability is highly underestimated. The aim of this study was to evaluate local toxicity in a patient using magnetic resonance imaging. A patient who gave written informed consent received a medically indicated intramuscular administration of diclofenac 75 mg/2 mL. Simultaneously with magnetic resonance imaging of the depot, a clinical-chemical evaluation and quantification of diclofenac in plasma was performed. A manifold enhancement of the T2-weighted magnetic resonance signal was observed in a muscle area of approximately 60 mL volume, with maximum signal intensity 30 min after injection, the time of maximum diclofenac plasma exposure. Plasma creatine kinase activity was elevated approximately sixfold within 8 h and normalized within 1 week, whereas the magnetic resonance enhancement disappeared within 5 weeks. Interestingly, the patient did not complain about any clinical symptoms at the injection site. Asymptomatic tissue injury after intramuscular injection of diclofenac, caused by intramuscular dosing, can be reliably evaluated by magnetic resonance imaging and should be applied early during the development of parenteral dosage forms. Clinical Trials Registration Number: BB130/16 (Ethics Committee of the University Medicine Greifswald).

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Conflict of interest statement

Funding

This work was supported by the InnoProfile grant COM_DAT [03IPT612X] of the German Federal Ministry of Education and Research (BMBF).

Conflicts of interest

Mareike Probst, Jens-Peter Kühn, Christiane Modeß, Eberhard Scheuch, Anne Seidlitz, Norbert Hosten, Werner Siegmund and Werner Weitschies declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
T2-weighted transverse magnetic resonance images of the left gluteal region before and after a 2 mL injection of diclofenac watery solution. Arrows indicate the site of injection and volume of the enhanced muscle tissue
Fig. 2
Fig. 2
CNR of the T2-enhanced muscle area (filled square), plasma concentrations of diclofenac (ng/mL, filled circle), and activity of creatine kinase (µkatal/L, filled triangle) after intramuscular injection of diclofenac 75 mg in a 2-mL solution. CNR contrast-to-noise ratio
See this image and copyright information in PMC

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