dye-KLOE-fen-ak
BEERS REMS
Contraindicated in:
Coronary artery bypass graft surgery
;Recent MI
;Use Cautiously in:
Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, MI, and stroke, especially with prolonged use or use of higher doses)
;History of long duration of NSAID use, smoking, alcohol use, advanced liver disease, coagulopathy, or poor general health (↑ risk of GI bleeding)
;History of peptic ulcer disease and/or GI bleeding
;Bleeding tendency or concurrent anticoagulant therapy
;Appears on Beers list. ↑ risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent
.CV: edema, HF, hypertension, MI
Derm: pruritus, rash, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), eczema, EXFOLIATIVE DERMATITIS, GENERALIZED BULLOUS FIXED DRUG ERUPTION, photosensitivity, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)
EENT: tinnitus
F and E: hyperkalemia
GI: abdominal pain, constipation, diarrhea, dyspepsia, flatulence, GI BLEEDING, GI PERFORATION, GI ULCERATION, heartburn, HEPATOTOXICITY, nausea, vomiting
GU: acute renal failure, hematuria
Hemat: anemia, prolonged bleeding time
Local: Topical onlycontact dermatitis, dry skin, exfoliation
Neuro: dizziness, headache, STROKE
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND SERIOUS SKIN REACTIONS)
Primarily noted for oral administration
Drug-drug:
↑risk of GI bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs
.Drug-Natural Products:
Diclofenac Potassium
Diclofenac Sodium
Diclofenac Epolamine
diclofenac potassium (oral): Cambia, Cataflam, Lofena, Zipsor,
diclofenac sodium (oral): Voltaren XR,
diclofenac sodium (topical gel): Solaraze, Aspercreme Arthritis Pain, Voltaren Arthritis Pain,
diclofenac sodium (topical solution): Pennsaid,
diclofenac epolamine (topical patch): Flector, Licart
Therapeutic Classification: antirheumatics, nonopioid analgesics
Pharmacologic Classification: nonsteroidal anti inflammatory drugs nsaids
Absorption: Undergoes first-pass metabolism by liver, which results in 50% bioavailability. Oral diclofenac sodium is a delayed-release dose form. Diclofenac potassium is an immediate-release dose form. 6–10% of topical gel is systemically absorbed.
Distribution: Crosses the placenta.
Protein Binding: >99%.
Half-Life: 2 hr.
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO (inflammation) | few days–1 wk | ≥2 wk | unknown |
| PO (pain) | 30 min | unknown | up to 8 hr |
| Top (gel and patch) | unknown | 10–20 hr | unknown |
| Top (solution) | unknown | unknown | unknown |
Topical
Inform patient of ↑ risk of MI and stroke. Use lowest effective dose for shortest time. Advise patient to notify health care provider immediately if signs and symptoms (shortness of breath or trouble breathing, chest pain, weakness in one part or side of body, slurred speech, swelling of the face or throat) occur.
Advise patient to notify health care provider promptly if signs or symptoms of GI toxicity (abdominal pain, black stools) occur.
NDC Code