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MUSCULO-SKELETAL SYSTEM › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS › Acetic acid derivatives and related substances
diclofenac, combinations
M01AB55
Forms & Strengths
- Topical Gel: 1% (Voltaren), 1.3%, 3%
- Topical Solution: 2%
- Oral Tablets (Delayed-Release): 25 mg, 50 mg, 75 mg
- Oral Tablets (Extended-Release): 100 mg
- Oral Capsules (Liquid-Filled): 35 mg
- Oral Powder for Solution: 40 mg, 50 mg
- Combination Products: Diclofenac/Misoprostol (50 mg/200 mcg, 75 mg/200 mcg)
Adult Dosing
- Osteoarthritis: 50 mg orally 2-3 times daily or topical gel (4g to affected joint up to 4 times daily)
- Rheumatoid Arthritis: 50 mg orally 3-4 times daily or 75 mg twice daily
- Ankylosing Spondylitis: 25 mg orally 4 times daily with an extra 25 mg at bedtime if needed
- Acute Pain/Dysmenorrhea: 50 mg orally 3 times daily
- Maximum oral dose: 150 mg/day (prescription formulations)
Pediatric Dosing
- Safety and efficacy not established in pediatric patients under 18 years of age for most formulations
- Juvenile idiopathic arthritis (oral formulations >1 years old): 2-3 mg/kg/day in divided doses
Indications
- Signs and symptoms of osteoarthritis
- Signs and symptoms of rheumatoid arthritis
- Signs and symptoms of ankylosing spondylitis
- Management of acute pain and primary dysmenorrhea
- Actinic keratoses (topical 3% gel)
Mechanism of Action
- Nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2)
- Decreases synthesis of pro-inflammatory prostaglandins from arachidonic acid
- Possesses analgesic, anti-inflammatory, and antipyretic properties
Contraindications
- Known hypersensitivity to diclofenac or severe allergic reactions (e.g., anaphylaxis, asthma) to aspirin or other NSAIDs
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Setting of coronary artery bypass graft (CABG) surgery perioperative pain
- Active peptic ulcer disease or gastrointestinal bleeding
- Severe hepatic or renal impairment
Adverse Reactions
- Cardiovascular: Thrombotic events, myocardial infarction, stroke, hypertension, edema
- Gastrointestinal: Dyspepsia, nausea, abdominal pain, GI ulceration, bleeding, perforation
- Renal: Renal papillary necrosis, acute renal failure, hyperkalemia
- Hepatic: Elevations of liver transaminases, severe hepatotoxicity
- Dermatologic: Application site reactions (topical), rash, pruritus
- Hematologic: Anemia, prolonged bleeding time
Drug Interactions
- Anticoagulants (e.g., warfarin) and antiplatelet agents (e.g., aspirin): Increased risk of severe GI bleeding
- ACE inhibitors, angiotensin II receptor blockers (ARBs), and diuretics: Decreased antihypertensive efficacy and increased risk of renal impairment
- Lithium: Decreased renal clearance, leading to elevated serum lithium toxicity levels
- Methotrexate: Decreased elimination and increased risk of severe methotrexate toxicity
- CYP2C9 inhibitors (e.g., fluconazole): Increased diclofenac plasma concentrations and exposure
Curated Content: Needs Vetting Before Put to Clinical Use