II. Medications: Diclofenac
- Diclofenac Solution (Pennsaid 1.5%)
- Diclofenac Gel (Voltaren Gel 1.5%)
- Diclofenac Patch (Flector Patch)
III. Medications: Other NSAIDs
- Pharmacy may compound other NSAIDs (e.g. Ketoprofen, Piroxicam, Ibuprofen)
IV. Dosing: Diclofenac 1% gel applied to affected joints
- Will be OTC without a prescription in 2020
- Measure gel on a dosing card and massage into affected area
- Two grams is 2.25 inches (6 cm) long when squeezed from tube
- Four grams is 4.5 inches (11.5 cm) long when squeezed frin tube
- Overall maximum: 32 grams/day over all affected joints
- Elbow, hand or wrist: 2 grams applied up to 4 times daily (maximum 8 grams/day/joint)
- Knee, ankle or foot: 4 grams applied up to 4 times daily (maximum 16 grams/day/joint)
- Not recommended for larger joints (hip, Shoulder), as likely to be ineffective
- May use for up to 7 days
V. Precautions
- Despite low absorption (<10%), cardiovascular and renal risks may still pertain to Topical NSAIDs
- Do not combine with other topicals or other NSAID forms
- Do not apply heat to application site
- Avoid washing area or showering for at least one hour after application
- Limit Topical NSAID to the shortest duration needed
VI. Pharmacokinetics
- Systemic absorption <10% (gel may be 6%)
VII. Adverse effects
VIII. Efficacy
-
Knee Osteoarthritis pain relief was equivalent for Topical Diclofenac as for oral Diclofenac
- However, topical caused only local skin irritation, and oral Diclofenac had gastrointestinal adverse effects
- Tugwell (2004) J Rheumatol 31(10): 2002-12 +PMID:15468367 [PubMed]
- Acute musculoskeletal pain reduced by >50% with Topical Steroid (Number Needed to Treat 1.8)
IX. Contraindications
- Absolute
- CABG history
- Asthma or aspirin Hypersensitivity
- Advanced renal disease
- Relative (use with caution in this group)
- Known cardiovascular disease
- Known Peptic Ulcer Disease (however topical Diclofenac did not appear to increase ulcer risk)
- Hypertension (however topical Diclofenac did not appear to increase Blood Pressure)
- Hepatic insufficiency
- Advanced Chronic Kidney Disease
- Congestive Heart Failure or other edematous condition
X. References
- (2016) Presc Lett 23(1): 2
- DeLaney in Herbert (2017) EM:Rap 17(11): 11-2
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Related Studies
| pennsaid (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PENNSAID 2% PUMP | Generic | $13.39 per gram |