Diacerein

Diacerein is a disease-modifying osteoarthritis drug (DMOAD) specifically formulated for the management of osteoarthritis symptoms, particularly of the knee and hip. Unlike conventional analgesics or NSAIDs that primarily offer symptomatic relief, diacerein works by inhibiting interleukin-1 beta, a key pro-inflammatory cytokine involved in cartilage degradation. This mechanism provides not only reduction in pain and stiffness but also demonstrates potential chondroprotective properties, slowing disease progression. It is indicated for adults and requires consistent use over weeks to achieve optimal therapeutic effect.

Features

• Active ingredient: Diacerein 50 mg
• Pharmacological class: Interleukin-1 inhibitor
• Presentation: Capsules or tablets
• Prescription status: Prescription-only in most regions
• Onset of action: Gradual, with full effects typically observed after 4–6 weeks of continuous use

Benefits

• Reduces pain and improves joint function in osteoarthritis patients
• Exhibits disease-modifying potential by slowing cartilage breakdown
• Provides sustained symptomatic relief with long-term use
• Lower risk of gastrointestinal adverse effects compared to traditional NSAIDs
• Does not suppress prostaglandin synthesis, reducing renal and cardiovascular risks associated with COX inhibition
• May delay or reduce the need for surgical intervention in advanced osteoarthritis

Common use

Diacerein is primarily used for the symptomatic treatment of osteoarthritis, especially in cases involving large weight-bearing joints such as the knee and hip. It is suitable for patients who require long-term management and where inflammation and cartilage degradation are key concerns. It is often considered when NSAIDs are contraindicated or poorly tolerated, or as an adjunct in a comprehensive osteoarthritis management plan that includes physical therapy and weight management.

Dosage and direction

The recommended adult dosage is 50 mg (one capsule/tablet) taken twice daily, preferably with meals to minimize gastrointestinal discomfort. Treatment should be initiated under medical supervision. For elderly patients or those with mild hepatic impairment, a dosage of 50 mg once daily may be recommended initially. The full therapeutic effect is usually achieved after 2–4 weeks of continuous administration. Treatment may be continued for several months based on clinical response and tolerability.

Precautions

Use with caution in patients with known gastrointestinal disorders, as diacerein may cause diarrhea or abdominal pain. Hepatic function should be monitored periodically during long-term therapy. Not recommended during pregnancy or lactation unless clearly necessary. Patients should be advised that the onset of action is gradual and that consistent use is required. Discontinuation should be considered if severe diarrhea or yellowish discoloration of the skin occurs (may indicate accumulation).

Contraindications

Hypersensitivity to diacerein or any excipients in the formulation. Patients with severe hepatic impairment or acute liver disease. History of chronic diarrhea or inflammatory bowel disease. Not recommended in children or adolescents under 18 years of age. Should not be used in patients with known hypersensitivity to anthraquinones.

Possible side effects

Common side effects include mild to moderate diarrhea, abdominal pain, and soft stools, which often subside with continued use. Less frequently, nausea, dyspepsia, and epigastric discomfort may occur. Urine may appear yellowish—this is harmless and related to rhein excretion. Rare cases of hepatitis and skin reactions such as rash or pruritus have been reported. Severe diarrhea may necessitate dose reduction or discontinuation.

Drug interaction

No clinically significant pharmacokinetic interactions have been reported with common osteoarthritis co-therapies such as paracetamol or topical NSAIDs. However, concomitant use with laxatives or other bowel motility-affecting agents may exacerbate gastrointestinal side effects. Theoretical interactions exist with drugs metabolized by CYP2C9 or CYP2C19, though clinical relevance is low. Always inform your physician of all concomitant medications.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Consistency in dosing is important to maintain steady-state concentration and efficacy.

Overdose

There is limited clinical data on diacerein overdose. Symptoms may include severe diarrhea, abdominal cramps, and dehydration. Management is supportive, including fluid and electrolyte replacement. Gastric lavage may be considered if ingestion was recent. There is no specific antidote.

Storage

Store at room temperature (15–30°C), in a dry place protected from light and moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis, treatment decisions, and personalized dosage recommendations. Do not initiate, modify, or discontinue treatment without medical supervision.

Reviews

Clinical studies and meta-analyses support the efficacy and safety of diacerein in osteoarthritis management. Patients often report significant improvement in pain and mobility after several weeks of use, though gastrointestinal side effects are a common reason for discontinuation. Long-term users appreciate the sustained relief and the fact that it is not an NSAID. Medical professionals value its disease-modifying potential and favorable safety profile in appropriate patient populations.