Adult Dosing
Mild to moderate pain, dysmenorrhea
Note: Use lowest effective dose for shortest effective treatment duration, discontinue on occurrence of abnormal liver or renal test, administer with food
- Diclofenac potassium: 50 mg PO tid, start with 100 mg PO x 1. Max: 200 mg/day for first 24 hrs, thereafter 150 mg/day
- Cataflam: 50 mg PO tid; note: Initial dose of 100 mg followed by 50 mg will provide better relief in some patients
- Zipsor: 25 mg PO qid
- Zorvolex: 18 mg or 35 mg tid
Osteoarthritis
- Diclofenac potassium: 50 mg PO bid-tid, Max: 150 mg/day
- Diclofenac sodium (delayed release): 50 mg PO bid/tid; alt: 75 mg bid, Max: 150 mg/day
- Diclofenac sodium (extended release): 100 mg PO qd, Max: 100 mg/day
- Voltaren XR: 100 mg PO qd, Max: 100 mg/day
- Cataflam: 100-150 mg/day in divided doses, 50 mg PO bid-tid
Rheumatoid arthritis
- Diclofenac potassium: 50 mg PO tid-qid, Max: 200 mg/day
- Diclofenac sodium (delayed release): 50 mg PO bid-tid; Alt: 75 mg bid, Max: 200 mg/day
- Diclofenac sodium (extended release): 100 mg PO qd, may increase to 100 mg bid, Max: 200 mg/day
- Voltaren XR: Start 100 mg PO qd, may increase to 100 mg bid, Max: 200 mg/day
- Cataflam: 150-200 mg/day in divided doses, 50 mg PO tid/ qid
Note:
- Weigh potential benefit/risk of diclofenac and other treatment options available before selecting it for therapy, select least effective dose for shortest duration. Discontinue if abnormal liver or renal tests persist or worsen. Give with food. Do not crush/cut/chew extended release tablets
Ankylosing spondylitis
- Diclofenac sodium (extended release): 100-125 mg/day PO in divided doses as 25 mg qid and 25 mg qhs
Note: Use lowest effective dose for shortest effective treatment duration, discontinue on occurrence of abnormal liver or renal test, administer with food
Acute Treatment of Migraine
- Cambia: 50 mg PO x 1
- Note: Reconstitute by thoroughly mixing the contents of one packet into a cup containing 30-60 mL of water and drink immediately; use only water for mixing, consume on an empty stomach, select least effective dose for shortest duration. Safety and effectiveness of a second dose have not been established. Discontinue if abnormal liver function tests persists or worsens
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
[Outline]
- Use the lowest effective dose for the shortest duration possible in patients with known CV disease or risk factors for CV disease as it causes serious cardiovascular thrombotic events, myocardial infarction, and stroke
- Diclofenac causes inflammation, bleeding, ulceration, and perforation of the stomach, small intestine or large intestine. Restrict use in patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding
- If a serious GI adverse event is suspected, discontinue the therapy and promptly institute an alternative therapy
- Avoid long term therapy with the drug, concomitant use of oral corticosteroids or anticoagulants, smoking, use of alcohol
- Severe hepatotoxicity can occur any time during treatment, closely monitor (ALT and AST) levels periodically in patients receiving continues therapy. Use the lowest effective dose for the shortest duration possible to minimize the potential risk of hepatotoxicity
- Avoid concomitant use of drug known to be potentially hepatotoxic
- It lead to onset of hypertension or worsening of pre-existing hypertension, closely monitor blood pressure before initiating and during the treatment
- Use with caution in patients already taking thiazides or loop diuretics as it may hamper the therapeutic response of thiazides or loop diuretics. Closely monitor BP during the therapy
- Use cautiously in patients with fluid retention or heart failure, as it causes Fluid retention and edema
- Monitor for renal toxicity in long term treatment, including renal papillary necrosis and other renal injury. avoid use in advanced renal disease
- Restrict administration in patients with aspirin triad
- Discontinue the treatment at the first appearance of skin rash or any other sign of hypersensitivity like anaphylactoid reactions
- Do not administer in pregnant female after 30 weeks as it causes premature closure of the ductus arteriosus in the fetus
- Check hematologic profile including hemoglobin or hematocrit at regular intervals in patients on long-term treatment with NSAIDs as it may cause anemia due to fluid retention, occult or gross GI blood loss
- Diclofenac inhibits platelet aggregation and prolongs bleeding time in some patients, closely monitor patients those with coagulation disorders or receiving anticoagulants
- Cautiously administer in patients with pre-existing asthma/aspirin-sensitive asthma as it may exacerbate the symptoms
- Monitor for signs of GI bleeding. Perform CBC and other blood chemistries, liver function test and renal function test periodically
- Use with caution in older age, poor general health status, debilitated patients
- Concomitant use of ACEI, thiazides, loop diuretics increased risk of renal toxicity
- Third trimester use may cause premature closure of the ductus arteriosus
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Cardiovascular disorders
- Asthmatic patients
- Elderly
- Fluid retention
- Heart failure
- APD
Pregnancy Category:C (1st and 2nd trimester), D (3rd trimester)
Breastfeeding: Diclofenac has a short half-life and little glucuronide metabolite formation. Most reviewers consider diclofenac to be acceptable during breastfeeding. This information is based upon Lactmed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 November 2010). According to manufacturer's data, it is not known whether this drug is excreted in human milk. Manufacturer recommends discontinuation of nursing or discontinuation of therapy, by analyzing risk and benefit ratio in nursing mothers.
US Trade Name(s)
- Cambia
- Cataflam
- Voltaren-XR
- Zipsor
- Zorvolex
US Availability
diclofenac sodium (generic)
- Extended Release TABS: 100 mg
- Delayed Release TABS: 25, 50, 75 mg
diclofenac potassium (generic)
Cambia (diclofenac potassium )
- PWDR for SOLN: 50 mg/pckt
Cataflam (diclofenac potassium )
Voltaren-XR (diclofenac sodium )
Zipsor (diclofenac potassium )
Zorvolex
Canadian Trade Name(s)
- Apo-Diclo rapid
- Apo-Diclo
- Voltaren
- Voltaren SR
- VoltarenRapid
- NU Diclo
- NU Diclo SR
- PRO Diclo rapide
Canadian Availability
diclofenac sodium (generic)
- TABS: 25, 50 mg
- ETABS: 75, 100 mg
diclofenac potassium (generic)
Apo-Diclo rapid (diclofenac potassium )
Apo-Diclo SR (diclofenac sodium )
Apo-Diclo (diclofenac sodium )
NU Diclo (diclofenac sodium )
NU Diclo SR (diclofenac sodium )
Voltaren Rapid (diclofenac potassium )
Voltaren SR (diclofenac sodium )
Voltaren (diclofenac sodium )
PRO Diclo Rapide (diclofenac potassium )
UK Trade Name(s)
- Dicloflex
- Dicloflex SR
- Dicloflex Retard
- Diclomax SR
- Diclomax retard
- Double Action Pain Relief
- Fenactol
- Fenactol Retard
- Fenactol SR
- Motifene
- Rheumatac Retard
- Rhumalgan CR
- Rhumalgan SR
- Rhumalgan XL
- Volsaid retard
- Voltarol Rapid
- Voltarol dispersible tablet
- Voltarol SR and Retard
- Voltarol
UK Availability
diclofenac sodium (generic)
diclofenac potassium (generic)
Dicloflex (diclofenac sodium )
Dicloflex 75 mg SR (diclofenac sodium )
Dicloflex retard (diclofenac sodium )
Diclomax SR (diclofenac sodium )
Diclomax Retard
Double Action Pain Relief (diclofenac potassium )
Fenactol (diclofenac sodium )
Fenactol SR (diclofenac sodium )
Fenactol retard (diclofenac sodium )
Motifene (diclofenac sodium )
Rheumatac Retard (diclofenac sodium )
Rhumalgan CR (diclofenac sodium )
Rhumalgan SR (diclofenac sodium )
Rhumalgan XL(diclofenac sodium )
Volsaid retard (diclofenac sodium )
Voltarol Rapid (diclofenac potassium )
Voltarol dispersible tablet (diclofenac sodium)
Voltarol SR and Retard (diclofenac sodium)
Voltarol (diclofenac sodium)
Australian Trade Name(s)
- Fenac
- Voltaren
- Voltaren Rapid
- Dinac
- Imflac
- Viclofen
Australian Availability
diclofenac (generic)
Voltaren (diclofenac sodium )
Voltaren Rapid (diclofenac potassium)
Volfast (diclofenac potassium)
Fenac (diclofenac sodium )
Dinac (diclofenac sodium )
Imflac (diclofenac sodium )
Viclofen(diclofenac sodium )
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Zipsor 25 MG CAPS [Bottle] (XANODYNE PHARMACEUTICALS)
INC mg = $30
mg = $90 - Voltaren 0.1 % SOLN [Bottle] (ALCON VISION)
5 % = $76.99
15 % = $212.97 - Voltaren-XR 100 MG TB24 [Bottle] (NOVARTIS)
30 mg = $247
90 mg = $740.99 - Voltaren 1 % GEL [Tube] (ENDO PHARMACEUTICALS)
100 % = $42.99
300 % = $110.97 - Cataflam 50 MG TABS [Bottle] (NOVARTIS)
100 mg = $401.99
300 mg = $1183.94
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
18 yrs (Cambia)
