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Diclofenac Dosage, Warning, Pregnancy Safety

Diclofenac Dosage/Diclofenac is a Nonsteroidal Anti-inflammatory Drug. The mechanism of action of diclofenac is as a Cyclooxygenase Inhibitor. The physiologic effect of diclofenac is by means of Decreased Prostaglandin Production. The chemical classification of diclofenac is Nonsteroidal Anti-inflammatory Compounds.

Diclofenac is a nonsteroidal benzene acetic 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-prostaglandins. 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.

Indications of Diclofenac

Diclofenac tablet is used for the treatment, control, prevention, & improvement of the following diseases, conditions and symptoms

For the acute and chronic treatment of signs and symptoms of osteoarthritis and rheumatoid arthritis.
Diclofenac is non-steroidal anti-inflammatory drug (NSAID), indicated in the relief of all grades of pain and inflammation associated with a wide range of conditions, including arthritic conditions, acute musculo-skeletal disorders and other painful conditions resulting from trauma.
Osteoarthritis
Rheumatoid arthritis
Ankylosing spondylitis
Pain due to specially musculoskeletal system
Muscles stiffness in spinal
Muscles stiffness in muscle diseases
Muscles stiffness in the joint diseases
Lumbago
Low back pain
PLID
Pain caused by nonaticular rheutism
Muscles stiffness in nerve diseases
Morning stiffness
Multiple joint pain
Periarthritis of scapulohumeral
Ischiadynia

Therapeutic Indications of Diclofenac

Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors
Diclofenac sodium also is used topically as an ophthalmic solution for the treatment of postoperative ocular inflammation in patients undergoing cataract extraction.
Oral diclofenac sodium has been used for its antipyretic effect in the management of fever, usually associated with infection.
In one study, the antipyretic effect of usual dosages of diclofenac sodiumas delayed-release (enteric-coated) tablets was about equal to that of usual dosages of aspirin. The drug, however, should not be used routinely as an antipyretic because of its potential adverse effects.
Diclofenac sodium as delayed-release (enteric-coated) tablets also has been used for the symptomatic relief of dysmenorrhea.
Diclofenac potassium is used orally in the management of primary dysmenorrhea. Diclofenac potassium;
Diclofenac also has been used parenterally (a parenteral dosage form is currently not commercially available in the US) for the relief of acute or renal colic, and for relief of postoperative pain (including that associated with gynecologic and orthopedic surgery).
Diclofenac sodium also has been used orally for symptomatic relief of postoperative (including that associated with dental surgery), postpartum, and orthopedic (including musculoskeletal strains or sprains) pain, and visceral pain associated with cancer.
Diclofenac epolamine transdermal system is used for symptomatic relief of acute pain due to minor strains, sprains, and contusions.
Diclofenac potassium is used orally for symptomatic relief of postoperative pain (including that associated with orthopedic, gynecologic, and oral surgery) and orthopedic pain (including musculoskeletal sprains and traumatic joint distortions).
Oral or topical diclofenac has been used for the symptomatic treatment of infusion-related superficial thrombophlebitis.
Oral diclofenac also has been used for the symptomatic treatment of acute painful shoulder (bursitis and or tendinitis), sciatic pain, backache, myositis, and radiohumeral bursitis (radiohumeral epicondylitis, tennis elbow).
The drug has been injected locally (a parenteral dosage form currently is not commercially available in the US) for the relief of myofascial pain in a limited number of patients with fibrositis, but additional study is necessary.
Oral diclofenac has been effective in a limited number of patients for the symptomatic relief of acute gouty arthritis. The drug does not appear to correct hyperuricemia but has been used instead for its anti-inflammatory and analgesic effects to relieve pain, joint tenderness, and swelling associated with this condition.
Diclofenac has been used orally with good results in a number of children for the management of juvenile rheumatoid arthritis.
In the symptomatic treatment of ankylosing spondylitis, oral diclofenac appears to provide relief of spinal pain, tenderness and/or spasm, morning stiffness, and pain at rest (including night pain) and to improve motion, posture, chest expansion, and spinal mobility.
When used in the symptomatic treatment of rheumatoid arthritis, oral diclofenac has relieved pain and stiffness; reduced swelling, tenderness, and the number of joints involved; and improved mobility and grip strength.
In the symptomatic treatment of osteoarthritis, diclofenac has relieved pain and stiffness, improved knee joint function, and increased range of and functional activity.Diclofenac appears to be only palliative in these conditions and has not been shown to permanently arrest or reverse the underlying disease process.
Diclofenac sodium 1% gel is used topically for the symptomatic treatment of osteoarthritis-related joint pain. The gel is used for joints amenable to topical therapy (e.g., hands, knees); the gel has not been evaluated for use on joints of the spine, hip, or shoulder.
Diclofenac sodium in fixed combination with misoprostol is used orally for anti-inflammatory activity and analgesic effects in the symptomatic treatment of rheumatoid arthritis and osteoarthritis in patients at high risk of developing nonsteroidal anti-inflammatory agent (NSAIA)-induced gastric or duodenal ulcers and in patients at high risk of developing complications from these ulcers.
Diclofenac sodium is used orally for anti-inflammatory and analgesic effects in the symptomatic treatment of acute and chronic rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and other inflammatory conditions.
Diclofenac potassium is used orally for anti-inflammatory and analgesic effects in the symptomatic treatment of acute and chronic rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and other inflammatory conditions.
Topical or oral diclofenac has been used for the symptomatic treatment of infusion-related superficial thrombophlebitis.
Diclofenac sodium is used topically for the treatment of actinic keratoses.

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Contra-Indications of Diclofenac

Active peptic ulcer
Acute rhinitis
Allergic to thiocolchicoside
Asthma
Breastfeeding
Pregnant
Urticaria
Concurrent peptic ulcer, or history of ulcer disease
Allergy to indomethacin, aspirin, or other NSAIDs
Patients with nasal polyps reacting with an angioedema to other NSAIDs
Children under 2 years of age (with the exception of neonates with patent ductus arteriosus)
Some painkillers, including opioid pain killers;
Hypnotic drugs;
Psychotropic drugs;
Used monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine
Epilepsy;
Addiction or are recovering from addiction to another medication.
History of peptic ulcer disease,
Gastrointestinal bleeding,
Severe pre-existing renal and liver damage
Caution: pre-existing bone marrow damage (frequent blood cell counts are indicated)
Caution: bleeding tendencies of unknown origin
Caution: Parkinson’s disease, epilepsy, psychotic disorders (indomethacin may worsen these conditions)
Concurrent with potassium sparing diuretics
Patients who have a patent ductus arteriosus dependent heart defect (such as transposition of the great vessels)
Significant hypertension (high blood pressure)
Concomitant administration of lithium salts (such as lithium carbonate)

Dosage

Strengths: sodium 25 mg; potassium 50 mg; sodium 75 mg; sodium 100 mg; sodium 50 mg; 37.5 mg/mL; potassium 25 mg; sodium; 18 mg; 35 mg

Osteoarthritis

Diclofenac free acid capsules: 35 mg orally 3 times a day
Diclofenac potassium immediate-release tablets: 50 mg orally 2 or 3 times a day
Diclofenac sodium enteric-coated tablets: 50 mg orally 2 or 3 times a day or 75 mg orally 2 times a da
Maximum dose: 150 mg daily
Diclofenac sodium extended-release tablets: 100 mg orally once a day

Ankylosing Spondylitis

Diclofenac sodium enteric-coated and delayed-release tablets: 25 mg orally 4 times a day. An additional 25 mg dose may be administered at bedtime, if necessary
Maximum dose: 125 mg per day

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Dysmenorrhea

Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day

Rheumatoid Arthritis

Diclofenac potassium immediate-release tablets

50 mg orally 3 or 4 times a day

Diclofenac sodium enteric-coated and delayed-release tablets

50 mg orally 3 to 4 times a day or 75 mg orally twice a day
Maximum dose: 225 mg daily

Diclofenac sodium extended-release tablets

100 mg orally once a day
Maximum dose: 100 mg orally 2 times a day; this would be for the rare patient in whom the benefits outweigh the clinical risks.

Migraine

Diclofenac potassium for oral solution packets: 50 mg (1 packet) orally once

Pain oral

25 mg orally 4 times a day
Diclofenac free acid capsules: 18 mg or 35 mg orally 3 times a day

Diclofenac potassium immediate-release tablets

50 mg orally 3 times a day; an initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief in some patients.

Parenteral

37.5 mg IV bolus over 15 seconds every 6 hours as needed for pain
Maximum Dose: 150 mg per day

Side Effects of Diclofenac

The most common

More common

Abdominal or stomach pain,
Chills or fever
Headache,
Joint or back pain
Muscle aching or cramping
Muscle pains or stiffness
Chest pressure or squeezing pain in chest
Excessive sweating
feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
sudden tingling or coldness in an arm or leg
Constipation
Diarrhoea
Loss of muscle coordination
Sleepiness or unusual drowsiness
Clumsiness or unsteadiness
Drowsiness

Rare

Anxiety
change in vision
seizures
abnormal or fast heart rate
weight loss
chest pain or tightness
confusion
cough
Agitation
arm, back, or jaw pain
blurred vision
chest pain or discomfort
convulsions
extra heartbeats, fainting
blurred vision
chest pain or discomfort
convulsions
extra heartbeats
hallucinations
headache
irritability
lightheadedness
mood or mental changes
muscle pain or cramps
muscle spasm or jerking of all extremities
muscle pains or stiffness
chest pressure or squeezing pain in chest
discomfort in arms, shoulders, neck or upper back
pain or discomfort in the chest, upper stomach, or throat
pale or blue lips, fingernails, or skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
unusual drowsiness, dullness, or feeling of sluggishness

Drug Interactions of Diclofenac

Diclofenac may interact with following drugs, supplements & may change the efficacy of drugs

antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
bisphosphonates (e.g., alendronate, etidronate, risedronate, zoledronic acid)
antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine,risperidone)
angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril)
angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
beta-adrenergic blockers (e.g., metoprolol, atenolol)
baclofen
barbiturates (e.g., butalbital, phenobarbital)
benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
celecoxib
cilostazol
“azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
clopidogrel
corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
cyclosporine
diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
5-ASA medications (e.g, sulfasalazine)
glucosamine
haloperidol
heparin
methotrexate
multivitamins
other non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, ketorolac, naproxen)
Omega-3 fatty acids
phenytoin
phenobarbital
pentoxifylline
quinolone antibiotics (e.g., ciprofloxacin, ofloxacin)
selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine,fluoxetine, paroxetine, sertraline)
serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., duloxetine, venlafaxine)
tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
warferin

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Pregnancy and Lactation of Diclofenac

FDA Pregnancy Category D

Pregnancy

You should not take Diclofenac Tablets during the last 3 months of pregnancy as it may affect the baby s circulation. If you are in the first 6 months of pregnancy talk to your doctor before taking this medicine as Diclofenac Tablets should only be taken if the benefit is likely to outweigh the risks.Taking Diclofenac Tablets may make it more difficult for you to get pregnant. You should talk to your doctor if you are planning to become pregnant or if you have problems getting pregnant.

Lactation

It is not known if diclofenac passes into breast milk. Due to the potential for harm to a baby, if they are exposed to this medication, breastfeeding must be stopped before starting this medication.

Important information of Diclofenac

You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).

Diclofenac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.