Diclofenac

General

• Type: NSAID
• Dosage Forms: PO (18 and 35mg tabs)
• Common Trade Names: Zorvolex

Adult Dosing

Pain, mild-moderate

• 18-35mg PO TID

Osteoarthritis

• 35mg PO TID

Pediatric Dosing

NA

Special Populations

• Pregnancy Rating: C, category D if >30wks after gestation
• Lactation: probably safe
• Renal dosing:
  • advanced renal disease: closely monitor renal fxn, no supplement
• Hepatic dosing
  • max 54mg/day

Contraindications

• allergy to class/drug
• ASA or NSAID-induced asthma or urticaria
• pregnancy starting at 30wk gestation
• CABG surgery periop use
• caution in elderly or debilitated pts
• caution if renal impairment
• caution if hepatic impairment
• caution if asthma
• caution if recent MI
• caution if cardiovascular dz
• caution if cardiac dz risk
• caution if HTN
• caution if CHF
• caution if fluid retention
• caution if coagulation disorder
• caution if GI bleeding or ulcer hx
• caution if alcohol use
• caution if smoker
• caution if dehydration
• caution if prolonged use
• caution if PKU

Adverse Reactions

Serious

• GI bleeding
• GI perforation/ulcer
• MI
• stroke
• thromboembolism
• HTN
• CHF
• renal papillary necrosis
• nephrotoxicity
• hepatotoxicity
• hepatic necrosis
• pancreatitis
• anaphylactoid rxn
• bronchospasm
• exfoliative dermatitis
• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• erythema multiforme
• anemia
• blood dyscrasias
• prolonged bleeding time

Common

• dyspepsia
• nausea
• vomiting
• abdominal pain
• diarrhea
• constipation
• flatulence
• headache
• dizziness
• rash
• pruritis
• ALT, AST elevated
• urticaria
• drowsiness
• fluid retention
• peripheral edema
• tinnitus
• ecchymosis
• sinusitis
• Cr elevation
• photosensitivity

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

See Also

NSAID