|•||PO: Management of inflammatory disorders including.
|•||Relief of mild to moderate pain.|
|•||Topical: Treatment of actinic keratoses.|
Different formulations of oral diclofenac (diclofenac sodium enteric-coated tablets, diclofenac sodium extended-release tablets, and diclofenac potassium immediate-release tablets are not bioequivalent and should not be substituted on a mg-to-mg basis.
|•||PO (Adults): Analgesic/antidysmenorrheal — 100 mg initially, then 50 mg 3 times daily as needed; Rheumatoid arthritis — 50 mg 3–4 times daily, after initial response reduce to lowest dose that controls symptoms; Osteoarthritis — 50 mg 2–3 times daily, after initial response reduce to lowest dose that controls symptoms .|
|•||PO (Adults): Rheumatoid arthritis (delayed-release [enteric-coated] tablets) — 50 mg 3–4 times daily or 75 mg twice daily; after initial resopnse reduce to lowest dose that controls symptoms (usual maintenance dose 25 mg 3 times daily). Rheumatoid arthritis (extended-release tablets) — 100 mg once daily, if unsatisfactory response, dose may be to 100 mg twice daily. Osteoarthritis (delayed-release [enteric-coated] tablets) — 50 mg 2–3 times daily or 75 mg twice daily; after initial response, to lowest dose that controls symptoms. Osteoarthritis (extended-release tablets) — 100 mg once daily. Ankylosing spondylitis (delayed-release [enteric-coated] tablets)– 25 mg 4 times daily, with an additional 25 mg given at bedtime, if necessary.|
|•||Topical (Adults): Apply to lesions twice daily for 60–90 days.|
|•||Inhibits prostaglandin synthesis.|
|•||Suppression of pain and inflammation.|
|•||Topical: Clearance of actinic keratosis lesions.|
Treatment of perioperative pain in the setting of coronary artery bypass graft surgery; patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or another NSAID; hypersensitivity to diclofenac or any component of the product. Do not apply topical patch to nonintact or damaged skin regardless of the cause (eg, burns or wounds, eczema, exudative dermatitis, infected lesion).
Use Cautiously in:
|•||Severe renal/hepatic disease.|
|•||Cardiovascular disease or risk factors for cardiovascular disease (may increases risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use).|
|•||History of porphyria.|
|•||History of peptic ulcer disease and/or GI bleeding.|
|•||Geri: Geriatric patients (dosage reduction recommended; more susceptible to adverse reactions, including GI bleeding).|
|•||Bleeding tendency or concurrent anticoagulant therapy.|
|•||OB: /Lactation: Pregnancy and lactation (not recommended for use during second half of pregnancy).|
|•||Pedi: Pregnancy, lactation, and children (safety not established).|
For oral diclofenac unless noted
CNS: dizziness, headache .
GI: GI bleeding, abdominal pain , constipation, diarrhea, dyspepsia , flatulence, heartburn, liver enzyme elevation, nausea, vomiting .
GU: acute renal failure, hematuria .
F and E: edema .
Hemat: anemia, prolonged bleeding time.
Primarily noted for oral administration
|•||increase adverse GI effects with aspirin, other NSAIDs, or corticosteroids .|
|•||May decrease effectiveness of diuretics, or antihypertensives.|
|•||May increase levels/risk of toxicity from cyclosporine, lithium, or methotrexate.|
|•||increase risk of bleeding with some cephalosporins, thrombolytic agents, antiplatelet agents, or warfarin.|
|•||Concurrent use of oral NSAIDs during topical diclofenac therapy should be minimized.|
|•||increase bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.|
Therapeutic Classification: nonopioid analgesics, nonsteroidal anti-inflammatory agents
Absorption: Undergoes first-pass metabolism by liver which results in 50% bioavailability Oral diclofenac sodium is a delayed-release dosage form. Diclofenac potassium is an immediate-release dosage form. 10% of topically applied diclofenac is systemically absorbed.
Distribution: Crosses the placenta.
Protein Binding: >99%.
Metabolism/Excretion: Metabolized by the liver to several metabolites; 65% excreted in urine, 35% in bile.
Half-life: 2 hr.
|ORAL(INFLAMMATION)||FEW DAYS 1WEEK||2 WEEKS OR MORE||UNKNOWN|
|ORAL (PAIN)||30 MINUTE||UNKNOWN||UPTO 8 HOUR|
*Complete healing of lesions following cessation of therapy