Diclofenac: Difference between revisions
 
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==General==
==General==
*Type: [[NSAID]]
*Type: [[NSAID]]
*Dosage Forms: PO (18 and 35mg tabs)
*Dosage Forms: Capsule 18mg, 25mg, 35mg; ER Tablet 100mg, 0.1% opthalmic solution, topical gel 1-3%
*Common Trade Names: Zorvolex
*Common Trade Names: Zorvolex


==Adult Dosing==
==Adult Dosing==
===Pain, mild-moderate===
===Pain, mild-moderate===
*18-35mg PO TID
*Tablet PO 50mg TID, may administer 100mg as first dose
 
===Ankylosing Spondylitis===
*PO Delayed Release 25mg 4x daily and 25mg qhs prn


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


==Contraindications==
==Contraindications==
*allergy to class/drug
*allergy to class/drug
*ASA or NSAID-induced asthma or urticaria
*ASA or NSAID-induced asthma or urticaria
*pregnancy starting at 30wk gestation
*caution if:
*CABG surgery periop use
**renal impairment, dehydration, elderly or debilitated
*caution in elderly or debilitated pts
**history of GI bleed or ulcers, alcohol use, or coagulopathy
*caution if renal impairment
**hepatic impairment
*caution if hepatic impairment
**asthma
*caution if asthma
**cardiovascular disease (or high risk of), including CABG surgery periop use, recent MI, CHF, HTN, smoker
*caution if recent MI
**fluid retention
*caution if cardiovascular dz
**PKU
*caution if cardiac dz risk
**prolonged use
*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==
==Adverse Reactions==
'''Serious'''
'''Serious'''
*GI bleeding
*GI bleed, ulcer, perforation
*GI perforation/ulcer
*blood dyscrasias, prolonged bleeding time, anemia
*MI
*nephrotoxicity, renal papillary necrosis
*stroke
*MI, stroke, thromboembolism, HTN, CHF
*thromboembolism
*hepatotoxicity, hepatic necrosis, pancreatitis
*HTN
*CHF
*renal papillary necrosis
*nephrotoxicity
*hepatotoxicity
*hepatic necrosis
*pancreatitis
*anaphylactoid rxn
*bronchospasm
*bronchospasm
*exfoliative dermatitis
*exfoliative dermatitis, SJS/TEN
*Stevens-Johnson syndrome
*toxic epidermal necrolysis
*erythema multiforme
*anemia
*blood dyscrasias
*prolonged bleeding time


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


==Pharmacology==
==Pharmacology==
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==See Also==
==See Also==
[[NSAID]]
*[[NSAID]]
*[[NSAID toxicity]]


[[Category: Pharmacology]]
[[Category: Pharmacology]]

Latest revision as of 22:34, 26 January 2019

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

See Also

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