II. Indications

  1. See NSAID
  2. Specific FDA-approved Diclofenac Indications
    1. Osteoarthritis
    2. Rheumatoid Arthritis
    3. Ankylosing Spondylitis
    4. Primary Dysmenorrhea
    5. Musculoskeletal Pain
    6. Migraine Headache (Cambia)

III. Contraindications

  1. See NSAID

IV. Mechanism

  1. See NSAID
  2. NSAID in Fenamate class

V. Precautions

  1. Other NSAIDs are preferred over Diclofenac
  2. Diclofenac has more adverse effects than other NSAIDs
    1. Cardiovascular Risk (similar to vioxx)
    2. Hepatotoxicity risk
    3. Increased GI toxicity risk
  3. References
    1. (2013) Presc Lett 20(7):42

VI. Medications

  1. Oral
    1. Diclofenac Potassium (Voltaren, Cataflam)
      1. Dose: 50 mg orally every 8 hours (Comparable to Aspirin)
      2. Faster absorption (hence faster onset) than Diclofenac Sodium (Voltaren)
    2. Diclofenac XR (Voltaren XR)
      1. Dose: 100 mg orally daily (up to twice daily)
    3. Diclofenac Powder (Cambia)
      1. Dissolve 50 mg packet in 30 to 60 ml water for Migraine Headache
    4. Arthrotec (50 mg Diclofenac with 200 mcg Misoprostol)
      1. Dose: 50/200 mg orally three times daily
      2. In addition to pregnancy-related NSAID contraindications, Misoprostol is also contraindicated in pregnancy
      3. Misoprostol may be associated with Diarrhea and Abdominal Pain
    5. Zorvolex 18 or 35 mg orally every 8 hours
      1. Released in 2014 as expensive, lower dose version of Diclofenac Potassium 50 mg
      2. No evidence of improved safety or similar efficacy to the lower priced, higher dose (50 mg) tablet
      3. Recommendations are still to use other systemic NSAIDs instead of Diclofenac
      4. (2014) Presc Lett 21(2): 9
  2. Topical
    1. Precautions
      1. Apply gel or patch only to unbroken skin
      2. Wash hands after applying gel or patch and avoid eye contact with product
      3. Do not wear patch while showering or bathing
    2. Diclofenac Gel (Pennsaid)
      1. Apply 2 gram dose to hands, 4 gram dose to knees
      2. Enclosed Card indicates 2 gram and 4 gram doses
    3. Flector Patch
      1. Applied to most painful area every 12 hours
    4. Licart Patch
      1. Applied to most painful area daily

VII. Adverse Effects

  1. See NSAID
  2. Hepatotoxicity
    1. Monitor Liver Function Tests at baseline, 4 and 8 weeks after starting, then periodically

VIII. Safety

  1. See NSAID
  2. Avoid in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

diclofenac (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DICLOFENAC 0.1% EYE DROPS Generic $1.98 per ml
DICLOFENAC 1.5% TOPICAL SOLN Generic $0.10 per ml
DICLOFENAC 2% SOLUTION PUMP Generic $13.39 per gram
DICLOFENAC EPOLAMINE 1.3% PTCH Generic $5.69 each
DICLOFENAC POT 50 MG POWDR PKT Generic $17.79 each
DICLOFENAC POT 50 MG TABLET Generic $0.20 each
DICLOFENAC POTASSIUM 25 MG CAP Generic $7.89 each
DICLOFENAC SOD DR 25 MG TAB Generic $0.80 each
DICLOFENAC SOD DR 50 MG TAB Generic $0.09 each
DICLOFENAC SOD DR 75 MG TAB Generic $0.09 each
DICLOFENAC SOD EC 25 MG TAB Generic $0.80 each
DICLOFENAC SOD EC 50 MG TAB Generic $0.09 each
DICLOFENAC SOD EC 75 MG TAB Generic $0.09 each
DICLOFENAC SOD ER 100 MG TAB Generic $1.09 each
DICLOFENAC SODIUM 1% GEL Generic OTC $0.07 per gram
DICLOFENAC SODIUM 3% GEL Generic $0.48 per gram
DICLOFENAC-MISOPROSTOL DR 50-0.2 MG TABLET Generic $1.02 each
DICLOFENAC-MISOPROSTOL DR 75-0.2 MG TABLET Generic $1.37 each

Ontology: Diclofenac (C0012091)

Definition (CHV) A non-steroidal anti-inflammatory agent
Definition (CHV) A non-steroidal anti-inflammatory agent
Definition (NCI_NCI-GLOSS) The active ingredient in a drug that is used to treat the symptoms of rheumatoid arthritis and is being studied in the prevention and treatment of some types of skin cancer. It blocks substances that cause inflammation and pain. It may also prevent the growth of new blood vessels that tumors need to grow. It is a type of cyclooxygenase inhibitor, a type of nonsteroidal anti-inflammatory drug (NSAID), and a type of antiangiogenesis agent.
Definition (NCI) A nonsteroidal benzeneacetic acid derivative with anti-inflammatory activity. As a nonsteroidal anti-inflammatory drug (NSAID), diclofenac binds and chelates both isoforms of cyclooxygenase (COX-1 and-2), thereby blocking the conversion of arachidonic acid to pro-inflammatory-proprostaglandins. This agent also may inhibit COX-2-mediated tumor angiogenesis. When inhibiting COX-2, diclofenac may be effective in relieving pain and inflammation; when inhibiting COX-1, it may produce unacceptable gastrointestinal side effects. This agent may be more active against COX-2 than several other carboxylic acid-containing NSAIDs. (NCI04)
Definition (MSH) A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004008
SnomedCT 350316001, 7034005, 363598004
LNC LP17915-7, MTHU024758
English Dichlofenal, Diclofenac, Diclophenac, Dicrofenac, Benzeneacetic acid, 2-((2,6-dichlorophenyl)amino)-, 2-[(2,6-Dichlorophenyl)amino]benzeneacetic Acid, diclofenac (medication), Diclofenac [Chemical/Ingredient], diclophenac, Diclofenac (product), DICLOFENAC, diclofenac, Diclofenac (substance), Diclofenac product (product), Diclofenac product, Diclofenac product (substance)
Swedish Diklofenak
Czech diklofenak
Finnish Diklofenaakki
Russian DIKLOFENAK NATRIIA, NATRIIA DIKLOFENAK, DIKLOFENAK, ДИКЛОФЕНАК, ДИКЛОФЕНАК НАТРИЯ, НАТРИЯ ДИКЛОФЕНАК
Japanese シーコレン, ジクロード, スタフルミン, ダイスパス, ナボールSR, ブセトン徐放カプセル, ボルマゲン, アデフロニック, イリナトロン, クロルギー, サビスミンTP, ストロングコールSR, フェニタレン, ブレシン, ボルタレン, ボンフェナック, ジクロニック, ジクロフェナクナトリウム, ジフェナック, ボナフェック, メクロフェン, ワンフェロン, ガウテリン, サンナックス, ジクロフェナク(Diclofenac Sodium), ジクロフェナック, ソレルモン, ネリオジン, ボラボミン, ヨウフェナック, サフラック, ソファリン, チカタレン, ナトリウムジクロフェナク, ニフレリール, メリカット, ジクロスター, ジクロフェナックナトリウム, ドセル錠, プロフェナチン, アナバン, ドンジャストA, バレタン, フェナシドン, ベギータ, アロンピン, ジクロフェノン, ピナナック, レクトス, ジクロフェナク, アスピゾン
Spanish diclofenac, producto (producto), diclofenac, producto, diclofenaco (sustancia), diclofenaco, diclofenac, diclofenaco (producto), diclofenac (sustancia), diclofenac (producto), Diclofenaco
Italian Diclofenal, Diclofenac
Croatian DIKLOFENAK
Polish Diklofenak
French Diclofenac
German Diclofenac, Diclophenac
Portuguese Diclofenaco