Voltaren, Voltaren-XR, Solaraze
Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid); antipyretic; Therapeutic: nsaid, analgesic; antipyretic
Pregnancy Category: B
Diclofenac Sodium: 25 mg, 50 mg, 75 mg tablets; 100 mg sustained release tablets; 0.1% ophthalmic solution; 3% gel
Diclofenac Potassium: 50 mg tablets
Diclofenac competitively inhibits both cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, by blocking arachidonic acid conversion
to other chemicals, thus leading to its analgesic, antipyretic, and antiinflammatory pharmacologic effects. It appears to
be a potent inhibitor of cyclooxygenase, thereby decreasing the synthesis of prostaglandins.
Nonsteroidal antiinflammatory drug (NSAID) with analgesic and antipyretic activity.
Analgesic and antipyretic effects in symptomatic treatment of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.
Also acute gout; juvenile rheumatoid arthritis; various rheumatic conditions including bursitis, myalgia, sciatica, and
tendinitis; acute soft tissue injuries including sprains and strains; dysmenorrhea; headache, migraine, and dental, minor
surgical, and postpartum pain; and renal or biliary colic. Ophthalmic: Cataract surgery; photophobia associated with refractive surgery. Topical: Treatment of actinic keratosis.
Hypersensitivity to diclofenac, NSAIDS, or salicylate; patients in whom asthma, urticaria, angioedema, bronchospasm, severe rhinitis, history of GI bleeding;
hepatic porphyria; shock, or other sensitivity reaction is precipitated by aspirin or other NSAIDS; postoperative CABG pain.
Geriatric patients and children; patients receiving anticoagulant therapy; diabetes mellitus; history of GI disease; hepatic
disease; GU tract problems such as dysuria, cystitis, hematuria, nephritis, nephrotic syndrome, patients who must restrict
their sodium intake; impaired hepatic function; SLE; heart failure, cardiac disease; hypertension; pregnancy (category B),
Route & Dosage
Adult: PO 150200 mg/d in 34 divided doses
Child: PO 25 mg b.i.d. or t.i.d.
Adult: PO 100150 mg/d in 34 divided doses 100 mg sustained release q.d.
Adult: PO 25 mg q.i.d. and 25 mg h.s.
Adult: Ophthalmic 1 drop of 0.1% solution in affected eye q.i.d. beginning 24 h after surgery and continuing for 2 wk
Adult: Topical Apply to affected area b.i.d. for 6090 d
- Ensure that sustained release or enteric coated forms of drug are not chewed or crushed. MUST be swallowed whole.
- Give on an empty stomach, 1 h before or after a meal; absorption is delayed markedly by food. Minimize gastric irritation
by administering it with a full glass of milk or water.
- Schedule administration 30 min before physical therapy or planned exercise to keep discomfort at a minimum.
- Discontinue therapy about 1 wk before surgery to reduce risk of bleeding.
- Use with caution in anyone who must restrict sodium intake.
- Store at 15°30° C (59°86° F) away from heat and direct light.
Adverse Effects (≥1%)CNS:
Dizziness, headache, drowsiness. Special Senses:
Rash, pruritus. GI: Dyspepsia,
nausea, vomiting, abdominal pain, cramps, constipation
, abdominal distension, flatulence, peptic
ulcer; liver enzymes, transaminases increased, liver test abnormalities. CV:
Fluid retention, hypertension, CHF. Respiratory: Asthma
. Body as a Whole:
Back, leg, or joint pain. Endocrine:
Prolonged bleeding time; inhibits platelet aggregation.
Diagnostic Test Interference
Liver function test values may be increased. Liver function test abnormalities may return to normal despite continued use;
however, if significant abnormalities occur, clinical signs and symptoms consistent with liver disease develop, or systemic
manifestations such as eosinophilia or rash occur, the medication should be discontinued. Serum uric acid concentrations
may be decreased because of increased renal clearance.
-induced nephrotoxicity; increases methotrexate
levels (increases toxicity
); may decrease BP-lowering effects of diuretics
; may increase levels and toxicity
may increase digoxin
levels. Herbal: Feverfew, garlic, ginger, ginkgo
may increase risk of bleeding.
Readily absorbed from GI tract; 5060% reaches systemic circulation. Peak:
23 h. Distribution:
Widely distributed including synovial fluid and into breast milk. Metabolism:
Extensively metabolized in liver. Elimination:
5070% in urine, 3035% in feces. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness. Up to 3 wk may be needed for beneficial effects with rheumatoid arthritis or osteoarthritis.
- Lab tests: Periodic liver function, serum uric acid concentrations Hct, PT/INR, and blood glucose.
- Observe and report signs of bleeding (e.g., petechiae, ecchymoses, bleeding gums, bloody or black stools, cloudy or bloody
- Monitor BP for hypertension and blood sugar for hyperglycemia.
- Monitor diabetics closely for loss of diabetic control.
- Monitor for increased serum sodium and potassium in patients receiving potassium-sparing diuretics.
- Monitor weight and report gains greater than 1 kg (2 lb)/24 h.
- Monitor for signs and symptoms of GI irritation and ulceration.
Patient & Family Education
- Do not lie down for 1530 min after taking medicine to decrease esophageal irritation.
- Discontinue use with onset of ringing or buzzing in the ears, impaired hearing, dizziness, GI discomfort, or bleeding and
- Do not take aspirin or other OTC analgesics without permission of the physician.
- Avoid alcohol or other CNS depressants.
- Do not drive or engage in other potentially hazardous activities until reaction to drug is known.
- Note: Diabetics need to monitor blood glucose carefully for loss of glycemic control.