Diclofenac
General
- Type: NSAID
- Dosage Forms: Capsule 18mg, 25mg, 35mg; ER Tablet 100mg, 0.1% opthalmic solution, topical gel 1-3%
- Common Trade Names: Zorvolex
Adult Dosing
Pain, mild-moderate
- Tablet PO 50mg TID, may administer 100mg as first dose
Ankylosing Spondylitis
- PO Delayed Release 25mg 4x daily and 25mg qhs prn
Osteoarthritis
- 35mg PO TID
Pediatric Dosing
NA
Special Populations
- Pregnancy Rating: C, category D if >30wks after gestation
- Lactation: probably safe
- Renal dosing: monitor renal function closely if advanced renal disease
- Hepatic dosing: max 54mg/day
Contraindications
- allergy to class/drug
- ASA or NSAID-induced asthma or urticaria
- caution if:
- renal impairment, dehydration, elderly or debilitated
- history of GI bleed or ulcers, alcohol use, or coagulopathy
- hepatic impairment
- asthma
- cardiovascular disease (or high risk of), including CABG surgery periop use, recent MI, CHF, HTN, smoker
- fluid retention
- PKU
- prolonged use
Adverse Reactions
Serious
- GI bleed, ulcer, perforation
- blood dyscrasias, prolonged bleeding time, anemia
- nephrotoxicity, renal papillary necrosis
- MI, stroke, thromboembolism, HTN, CHF
- hepatotoxicity, hepatic necrosis, pancreatitis
- bronchospasm
- exfoliative dermatitis, SJS/TEN
Common
- dyspepsia, nausea/vomiting, abdominal pain, diarrhea, constipation, flatulence
- headache, dizziness, drowsiness, tinnitus
- dizziness
- rash, pruritus, urticaria, photosensitivity
- fluid retention, peripheral edema
- ecchymosis
- elevated creatinine, ALT/AST
- sinusitis
Pharmacology
- Half-life: 1.9 hours
- Metabolism: liver; CYP450 (2C8, 2C9, 3A4 substrate), UGT (2B7 substrate)
- Excretion: urine 65%, bile 35%
- Mechanism of Action: exact MOA unknown; inhibits cyclooxyrgenase, reducing prostaglandin and thromboxane synthesis