diclofenac

Drug Name

Generic Name : diclofenac, diclofenac potassium, diclofenac sodium

Brand Name: Cataflam, Novo-Difenac-k (CAN), Voltaren Rapide (CAN), Novo-Difenac (CAN), Novo-Difenac SR (CAN), Nu-Diclo (CAN), Solaraze, Voltaren, Voltaren nu-Diclo SR (CAN), Ophtha (CAN), Voltaren-XR

Classification: Anti-inflammatory, NSAID

Pregnancy Category B

Dosage & Route
ADULTS

Oral

  • Pain, including dysmenorrhea: 50 mg tid PO; initial dose of 100 mg may help some patients (Cataflam).
  • Osteoarthritis: 100–150 mg/day PO in divided doses (Voltaren); 50 mg bid–tid PO (Cataflam).
  • Rheumatoid arthritis: 150–200 mg/day PO in divided doses (Voltaren); 50 mg bid–tid PO (Cataflam).
  • Ankylosing spondylitis: 100–125 mg/day PO. Give as 25 mg qid, with an extra 25-mg dose hs (Voltaren); 25 mg qid PO with an additional 25 mg at bedtime if needed (Cataflam).

Topical

  • Actinic keratosis: Cover lesion with gel and smooth into skin; do not cover with dressings or cosmetics (Solaraze).

Ophthalmic

  • 1 drop to affected eye qid starting 24 hr after surgery for 2 wk.
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
Therapeutic actions
  • Diclofenac has potent anti-inflammatory, analgesic and antipyretic actions. It inhibits the enzyme, cyclooxygenase, thus resulting in reduced synthesis of prostaglandin precursors.
Indications
  • Acute or long-term treatment of mild to moderate pain, including dysmenorrhea
  • Rheumatoid arthritis
  • Osteoarthritis
  • Ankylosing spondylitis
  • Treatment of actinic keratosis in conjunction with sun avoidance
  • Ophthalmic: Postoperative inflammation from cataract extraction
Adverse effects
  • GI disturbances; headache, dizziness, rash; GI bleeding, peptic ulceration; abnormalities of kidney function. Pain and tissue damage at Inj site (IM); local irritation (rectal); transient burning and stinging (ophthalmic).
  • Potentially Fatal: Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis.
Contraindications
  • Active peptic ulcer; hypersensitivity to diclofenac or other NSAIDs. Treatment of perioperative pain in CABG surgery. 3rd trimester of pregnancy. Topical: Not to be applied onto damaged or nonintact skin.
Nursing considerations
Assessment
  • History: Renal impairment; impaired hearing; allergies; hepatic, CV, and GI conditions; lactation, pregnancy
  • Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC, clotting times, renal function tests, LFTs, serum electrolytes, stool guaiac
Interventions
  • BLACK BOX WARNING: Be aware that patient may be at increased risk for CV events, GI bleed, renal insufficiency; monitor accordingly.
  • Administer drug with food or after meals if GI upset occurs.
  • Arrange for periodic ophthalmologic examination during long-term therapy.
  • WARNING: Institute emergency procedures if overdose occurs (gastric lavage, induction of emesis, supportive therapy).
Teaching points
  • Take drug with food or meals if GI upset occurs.
  • Take only the prescribed dosage.
  • You may experience these side effects: Dizziness, drowsiness (avoid driving or using dangerous machinery while using this drug).
  • Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision; black, tarry stools.