Analgesic

Diclofenac

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Diclofenac, Diclofenac gel, Voltaren, Arthrotec, Flector Patch, Licart Patch, Cambia, Zorvolex

  • See Also
  1. NSAID
  • Indications
  1. See NSAID
  2. Specific FDA-approved Diclofenac Indications
    1. Osteoarthritis
    2. Rheumatoid Arthritis
    3. Ankylosing Spondylitis
    4. Primary Dysmenorrhea
    5. Musculoskeletal Pain
    6. Migraine Headache (Cambia)
  • Contraindications
  1. See NSAID
  • Mechanism
  1. See NSAID
  2. NSAID in Fenamate class
  • Precautions
  1. Other NSAIDs are preferred over Diclofenac
  2. Diclofenac has more adverse effects than other NSAIDs
    1. Cardiovascular Risk (similar to vioxx)
    2. Hepatotoxicity risk
    3. Increased GI toxicity risk
  3. References
    1. (2013) Presc Lett 20(7):42
  • Medications
  1. Oral
    1. Diclofenac Potassium (Voltaren, Cataflam)
      1. Dose: 50 mg orally every 8 hours (Comparable to Aspirin)
      2. Faster absorption (hence faster onset) than Diclofenac Sodium (Voltaren)
    2. Diclofenac XR (Voltaren XR)
      1. Dose: 100 mg orally daily (up to twice daily)
    3. Diclofenac Powder (Cambia)
      1. Dissolve 50 mg packet in 30 to 60 ml water for Migraine Headache
    4. Arthrotec (50 mg Diclofenac with 200 mcg Misoprostol)
      1. Dose: 50/200 mg orally three times daily
      2. In addition to pregnancy-related NSAID contraindications, Misoprostol is also contraindicated in pregnancy
      3. Misoprostol may be associated with Diarrhea and Abdominal Pain
    5. Zorvolex 18 or 35 mg orally every 8 hours
      1. Released in 2014 as expensive, lower dose version of Diclofenac Potassium 50 mg
      2. No evidence of improved safety or similar efficacy to the lower priced, higher dose (50 mg) tablet
      3. Recommendations are still to use other systemic NSAIDs instead of Diclofenac
      4. (2014) Presc Lett 21(2): 9
  2. Topical
    1. Precautions
      1. Apply gel or patch only to unbroken skin
      2. Wash hands after applying gel or patch and avoid eye contact with product
      3. Do not wear patch while showering or bathing
    2. Diclofenac Gel (Pennsaid)
      1. Apply 2 gram dose to hands, 4 gram dose to knees
      2. Enclosed Card indicates 2 gram and 4 gram doses
    3. Flector Patch
      1. Applied to most painful area every 12 hours
    4. Licart Patch
      1. Applied to most painful area daily
  • Adverse Effects
  1. See NSAID
  2. Hepatotoxicity
    1. Monitor Liver Function Tests at baseline, 4 and 8 weeks after starting, then periodically
  • Safety
  1. See NSAID
  2. Avoid in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)
  • Resources
  1. Diclofenac Sodium (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f64b68a5-d6d2-4e92-87e7-90af04c1f9db
  2. Diclofenac Delayed Release (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3330ea92-fc9d-4541-b378-be399b0995d3
  3. Diclofenac XR (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=85ba4872-19db-2316-e053-2991aa0a00fc
  4. Diclofenac Topical Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ac82c08f-a2e9-433c-92ea-bef724169f20