Uses
Consider potential benefits and risks of diclofenac therapy as well as alternative therapies before initiating therapy with the drug. Use lowest effective dosage and shortest duration of therapy consistent with the patient's treatment goals.
Inflammatory Diseases
Symptomatic treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
Used in fixed combination with misoprostol for the symptomatic treatment of osteoarthritis and rheumatoid arthritis in patients at high risk for developing NSAIA-induced gastric or duodenal ulcers and in patients at high risk for developing complications from these ulcers.
Management of juvenile rheumatoid arthritis†.
Symptomatic relief of acute gouty arthritis†.
Symptomatic treatment of infusion-related superficial thrombophlebitis†.
Pain
Relief of pain, including postoperative (e.g., orthopedic, gynecologic, oral) pain, in adults.
Dysmenorrhea
Symptomatic management of primary dysmenorrhea.
Dosage and Administration
General
- Consider potential benefits and risks of diclofenac therapy as well as alternative therapies before initiating therapy with the drug.
Administration
Oral Administration
Diclofenac sodium delayed-release (enteric-coated) and extended-release tablets are not recommended for relief of acute pain or primary dysmenorrhea because of slow onset of action.
Dosage
Available as diclofenac potassium or diclofenac sodium; dosage expressed in terms of the salt.
To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with the patient's treatment goals. Adjust dosage based on individual requirements and response; attempt to titrate to the lowest effective dosage.
Commercially available diclofenac sodium enteric-coated tablets (Voltaren®), diclofenac sodium extended-release tablets (Voltaren®-XR), and diclofenac potassium immediate-release tablets (Cataflam®) are not necessarily bioequivalent on a mg-per-mg basis.
Adults
Inflammatory Diseases
Osteoarthritis
Oral
| Preparation |
Dosage |
| Diclofenac potassium conventional tablets |
100–150 mg daily, given as 50 mg 2 or 3 times daily |
| Diclofenac sodium delayed-release tablets |
100–150 mg daily, given as 50 mg 2 or 3 times daily or 75 mg twice daily |
| Diclofenac sodium extended-release tablets |
100 mg once daily |
| Diclofenac sodium (in fixed combination with misoprostol) |
50 mg 3 times daily |
| May change dosage to 50 or 75 mg twice daily in patients who do not tolerate usual dosage; however, these dosages may be less effective in preventing NSAIA-induced ulcers. |
Rheumatoid Arthritis
Oral
| Preparation |
Dosage |
| Diclofenac potassium conventional tablets |
150–200 mg daily, given as 50 mg 3 or 4 times daily |
| Diclofenac sodium delayed-release tablets |
150–200 mg daily, given as 50 mg 3 or 4 times daily or 75 mg twice daily |
| Diclofenac sodium extended-release tablets |
100 mg once daily; may increase to 100 mg twice daily |
| Diclofenac sodium (in fixed combination with misoprostol) |
50 mg 3 or 4 times daily |
| May change dosage to 50 or 75 mg twice daily in patients who do not tolerate usual dosage; however, these dosages may be less effective in preventing NSAIA-induced ulcers. |
Ankylosing Spondylitis
Oral
100–125 mg daily (as diclofenac sodium delayed-release tablets); administer as 25 mg 4 times daily, with 5th dose at bedtime as needed.
Pain
Oral
50 mg 3 times daily (as diclofenac potassium conventional tablets). Some patients may benefit from initial dose of 100 mg (followed by 50-mg doses).
Dysmenorrhea
Oral
50 mg 3 times daily (as diclofenac potassium conventional tablets). Some patients may benefit from initial dose of 100 mg (followed by 50-mg doses).
Special Populations
Dosage in Renal Impairment
Dosage adjustment not required.
Hepatic Impairment
Dosage reductions may be necessary.
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