Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging

J Pharm Pharmacol. 2019 Aug;71(8):1262-1270. doi: 10.1111/jphp.13105. Epub 2019 May 27.


Objectives: We investigated changes of renal perfusion after topical and oral diclofenac administration in healthy volunteers using functional magnetic resonance imaging (MRI) with arterial spin labelling (ASL).

Methods: Twenty-four healthy human participants (21-51 years) underwent 1.5T MRI before and 1 h after a single oral dose of diclofenac (50 mg). Twelve of 24 participants underwent an additional MRI examination following 3-day topical diclofenac administration. For renal perfusion imaging, a flow-sensitive alternating inversion-recovery TrueFISP ASL sequence was applied. Plasma concentrations of diclofenac and serum concentrations of thromboxane were determined.

Key findings: After oral diclofenac application, large interindividual differences in plasma concentrations were observed (range <3-4604 nm). Topical diclofenac application did not result in relevant systemic diclofenac levels (range 5-75 nm). MRI showed a significant reduction of renal perfusion in individuals with diclofenac levels ≥225 nm (baseline: 347 ± 7 vs diclofenac: 323 ± 8 ml/min/100 g, P < 0.01); no significant differences were observed in participants with diclofenac levels <225 nm. Diclofenac levels correlated negatively with thromboxane B2 levels pointing towards target engagement.

Conclusions: Single-dose diclofenac caused a decrease in renal perfusion in participants with diclofenac levels ≥225 nm. We demonstrated that even a single dose of diclofenac can impair renal perfusion, which could be detrimental in patients with underlying chronic kidney disease or acute kidney injury.

Keywords: arterial spin labelling; diclofenac; functional magnetic resonance imaging; non-steroidal anti-inflammatory drug; renal perfusion.

MeSH terms

  • Adult
  • Arteries / drug effects
  • Diclofenac / administration & dosage*
  • Diclofenac / adverse effects*
  • Female
  • Healthy Volunteers
  • Humans
  • Kidney / drug effects*
  • Kidney Diseases / chemically induced
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Perfusion / methods
  • Spin Labels
  • Young Adult


  • Spin Labels
  • Diclofenac