Diclofenac

Indications
 Oral
Sprains
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Strains
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Tendinitis
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Pain and inflammation associated with musculoskeletal and joint disorders
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Bursitis
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Acute gout
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Dysmenorrhoea
Adult: As sodium: 75-150 mg daily in divided doses. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Oral
Migraine
Adult: As potassium: Initially, 50 mg taken at the 1st sign of an attack, an additional dose of 50 mg may be taken after 2 hr if symptoms persist. If needed, further doses of 50 mg may be taken every 4-6 hr. Max: 200 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Intravenous
Postoperative pain
Adult: As sodium: 75 mg infusion in 5% glucose or 0.9% sodium chloride given over 30-120 minutes, may repeat after 4-6 hr if necessary.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Bursitis
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Sprains
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Strains
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Tendinitis
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Pain and inflammation associated with musculoskeletal and joint disorders
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Acute gout
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Dysmenorrhoea
Adult: As sodium: 75 mg once daily, injected into the gluteal muscle, may increase to 75 mg bid in severe conditions.
Hepatic impairment: Dose adjustment may be needed.
Intramuscular
Renal colic
Adult: As sodium: 75 mg, may repeat once after 30 minutes if needed. Max: 150 mg/day.
Hepatic impairment: Dose adjustment may be needed.
Intravenous
Prophylaxis of postoperative pain
Adult: As sodium: 25-50 mg infusion given after surgery over 15-60 minutes followed by 5 mg/hr. Max: 150 mg daily.
Hepatic impairment: Dose adjustment may be needed.
Ophthalmic
Postoperative ocular inflammation
Adult: As sodium (0.1% solution): Instill into the appropriate eye 4 times daily starting 24 hr after surgery for up to 28 days.
Ophthalmic
Prophylaxis of intra-operative miosis
Adult: As sodium (0.1% solution): Instill into the appropriate eye 4 times within 2 hr before surgery.
Ophthalmic
Post-photorefractive keratectomy pain
Adult: As sodium (0.1% solution): Instill into the eye twice in the hr before surgery, then 1 drop twice at 5-minute intervals immediately after surgery, then every 2-5 hr while awake for up to 24 hr.
Ophthalmic
Seasonal allergic conjunctivitis
Adult: As sodium (0.1% solution): Instill 1 drop into the affected eye(s) up to 4 times daily.
Ophthalmic
Pain and discomfort after radial keratotomy
Adult: As sodium (0.1% solution): Instill 1 drop before surgery followed by 1 drop immediately after surgery, and then 1 drop 4 times daily for up to 2 days.
Ophthalmic
Control of inflammation after argon laser trabeculoplasty
Adult: As sodium (0.1% solution): Instill 1 drop 4 times during the 2 hr before procedure followed by 1 drop 4 times daily, up to 7 days after procedure.
Ophthalmic
Inflammation and discomfort after strabismus surgery
Adult: As sodium (0.1% solution): Instill 1 drop 4 times daily for the 1st wk; then tid in the 2nd wk, bid in the 3rd wk, and as required for the 4th wk.
Ophthalmic
Pain after accidental trauma
Adult: As sodium (0.1% solution): Instill 1 drop 4 times daily for up to 2 days.
Topical/Cutaneous
Local symptomatic relief of pain and inflammation
Adult: As sodium (1% gel): Apply onto affected area 3-4 times daily.
Hepatic impairment: Dose adjustment may be needed.
Topical/Cutaneous
Osteoarthritis
Adult: As sodium (1.6% solution): Apply in small amounts (20-40 drops) onto affected area 4 times daily.
Hepatic impairment: Dose adjustment may be needed.
Topical/Cutaneous
Actinic keratoses
Adult: As sodium (3% gel): Apply bid for 60-90 days.
Hepatic impairment: Dose adjustment may be needed.
Rectal
Postoperative pain
Adult: 75-150 mg daily, in divided doses (25 mg, 50 mg and 100 mg suppositories only). Max: 150 mg/day (inclusive of diclofenac administered through other routes).
Child: 6-12 yr: 1-2 mg/kg/day in divided doses (12.5 mg and 25 mg suppositories only) for max of 4 days.
Hepatic impairment: Dose adjustment may be needed.
Contraindications
 Active peptic ulcer; hypersensitivity to diclofenac or other NSAIDs. Treatment of perioperative pain in CABG surgery. 3rd trimester of pregnancy. Topical: Not to be applied onto damaged or nonintact skin.
Warnings / Precautions
 History of GI ulceration; impaired cardiac, renal or hepatic function; hypertension; lactation. IV admin in patients with moderate or severe renal impairment; hypovolaemia or dehydration; asthma, porphyria. Monitor LFTs in patients on prolonged therapy. May prolong bleeding time; caution when used in patients with coagulation disorders or on anticoagulants. Prolonged therapy may increase risk of anaemia. 1st and 2nd trimester of pregnancy. Elderly, debilitated patients.
Adverse Reactions
 GI disturbances; headache, dizziness, rash; GI bleeding, peptic ulceration; abnormalities of kidney function. Pain and tissue damage at Inj site (IM); local irritation (rectal); transient burning and stinging (ophthalmic).
Potentially Fatal: Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis.
Overdose Reactions
 Symptoms: Lethargy, drowsiness, nausea, vomiting, and epigastric pain, GI bleeding. Hypertension, acute renal failure, respiratory depression, anaphylactoid reactions and coma may occur rarely. Treatment in symptomatic and supportive. Emesis and/or activated charcoal and/or osmotic cathartic may reduce drug absorption if present within 4 hr of ingestion. Forced diuresis, alkalinisation of urine, haemodialysis, or haemoperfusion unlikely to be useful.
Drug Interactions
 Not to be given IV to patients who are receiving other NSAIDs or anticoagulants including low dose heparin. Renal function may be worsened when used with ciclosporin or triamterene. Altered absorption when given with sucralfate, colestyramine or colestipol. Ophthalmic application of diclofenac may reduce the efficacy of ophthalmic acetylcholine and carbachol. Increased risk of GI ulceration and bleeding when used with corticosteroids, aspirin or anticoagulants.
Potentially Fatal: Increases blood levels of digoxin, lithium and methotrexate. Potentiate potassium-sparing diuretics.
See Below for More diclofenac Drug Interactions
Food Interactions
 Slow absorption of enteric-coated tab when given with food.
Mechanism of Actions
 Diclofenac has potent anti-inflammatory, analgesic and antipyretic actions. It inhibits the enzyme, cyclooxygenase, thus resulting in reduced synthesis of prostaglandin precursors.
Absorption: Rapidly absorbed (oral solution, rectal suppository, IM); more slowly (enteric-coated tab).
Distribution: Penetrates synovial fluid; enters breast milk (small amounts). Protein-binding: >99%.
Metabolism: Extensively hepatic; converted to metabolites.
Excretion: About 60% excreted in urine as glucuronide and sulfate conjugates; 35% in bile; 1-2 hr (elimination half-life).
Administration
 Should be taken with food. (Take immediately after meals.)
Storage Conditions
 Intramuscular: Store at 15-30°C. Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Oral: Store at 15-30°C. Rectal: Store at 15-30°C. Topical/Cutaneous: Store at 15-30°C.
ATC Classification
 D11AX18 - diclofenac ; Belongs to the class of other dermatologicals.
M01AB05 - diclofenac ; Belongs to the class of acetic acid derivatives and related substances of non-steroidal antiinflammatory and antirheumatic products.
M02AA15 - diclofenac ; Belongs to the class of non-steroidal antiinflammatory preparations for topical use. Used in the treatment of joint and muscular pains.
S01BC03 - diclofenac ; Belongs to the class of non-steroidal antiinflammatory agents. Used in the treatment of inflammation of the eye.
Storage
 Intramuscular: Store at 15-30°C. Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Oral: Store at 15-30°C. Rectal: Store at 15-30°C. Topical/Cutaneous: Store at 15-30°C.
Available As
  • Diclofenac 0.01%
  • Diclofenac 0.074% w/v
  • Diclofenac 0.074% w/w
  • Diclofenac Sodium 0.1%
  • Diclofenac 0.1%
  • Diclofenac 0.1% w/v
  • Diclofenac Sodium 0.1% w/v
  • Diclofenac 0.1% w/w
  • Diclofenac Sodium 0.10% w/v
  • Diclofenac Sodium 1 mg
  • Diclofenac Sodium 1%
  • Diclofenac 1%
  • Diclofenac 1% w/w
  • Diclofenac Sodium 1% w/w
  • Diclofenac Diethylammonium 1% w/w
  • Diclofenac Diethylamine 1% w/w
  • Diclofenac Diethyl Ammonium 1% w/w
  • Diclofenac Sodium 1% ww
  • Diclofenac Diethylamine 1.0% w/w
  • Diclofenac Sodium 1.00% w/w
  • Diclofenac Diethylamine 1.116% w/w
  • Diclofenac Diethylammonium 1.13%
  • Diclofenac Diethylamine 1.16 % w/w
  • Diclofenac Diethylamine 1.16%
  • Diclofenac Diethylammonium 1.16%
  • Diclofenac Diethyl Ammonium 1.16%
  • Diclofenac 1.16%
  • Diclofenac Sodium 1.16%
  • Diclofenac Diethylamine 1.16% w/v
  • Diclofenac Diethyl Ammonium 1.16% w/w
  • Diclofenac 1.16% w/w
  • Diclofenac Sodium 1.16% w/w
  • Diclofenac Diethylammonium 1.16% w/w
  • Diclofenac Diethylamine 1.16% w/w
  • Diclofenac Potassium 10 mg
  • Diclofenac Sodium 10 mg
  • Diclofenac 10 mg
  • Diclofenac Diethylammonium 10 mg
  • Diclofenac Diethylamine 10% w/w
  • Diclofenac Sodium 100 mg
  • Diclofenac 100 mg
  • Diclofenac Potassium 100 mg
  • Diclofenac Diethylammonium 11.6 mg
  • Diclofenac 11.6 mg
  • Diclofenac Sodium 12.5 mg
  • Diclofenac 150 mg
  • Diclofenac 16% w/w
  • Diclofenac Diethylammonium 2% w/w
  • Diclofenac 2.32% w/w
  • Diclofenac 200 mg
  • Diclofenac Potassium 25 mg
  • Diclofenac Sodium 25 mg
  • Diclofenac 25 mg
  • Diclofenac Sodium 25, 75 mg
  • Diclofenac 250 mg
  • Diclofenac Sodium 3% w/w
  • Diclofenac Sodium 46.5 mg
  • Diclofenac 46.5 mg
  • Diclofenac Acid 46.5 mg
  • Diclofenac Acid 50 mg
  • Diclofenac Potassium 50 mg
  • Diclofenac Sodium 50 mg
  • Diclofenac 50 mg
  • Diclofenac Potassium 500 mg
  • Diclofenac Acid 69.75 mg
  • Diclofenac Potassium 75 mg
  • Diclofenac 75 mg
  • Diclofenac Sodium 75 mg
  • Diclofenac Sodium 80 mg

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