Diclofenac: Difference between revisions

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{{MedTemplate

| generic = Diclofenac

| generic = Diclofenac (sodium, potassium, epolamine; multiple salt forms)

| brand = Voltaren

| brand = Voltaren (IR oral, topical gel), Cataflam (potassium IR), Cambia (oral powder, migraine), Zorvolex (low-dose), Pennsaid (topical 2% solution), Flector (transdermal patch), Solaraze (3% gel for actinic keratosis)

| ~~classes~~ = ~~NSAID~~

| structure =

| ~~intro~~ = ~~Diclofenac is a non-selective non~~-steroidal anti-inflammatory ~~drug~~ (NSAID), ~~widely used for~~ musculoskeletal pain ~~and inflammation~~; ~~available~~ in oral, topical, and ~~parenteral forms~~.

| classes = [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]], [[:Category:Analgesics|Analgesic]]

| uses = <vote slug="osteoarthritis-use">Osteoarthritis (FDA)</vote>, <vote slug="rheumatoid-arthritis-use">Rheumatoid arthritis (FDA)</vote>, <vote slug="ankylosing-spondylitis-use">Ankylosing spondylitis (FDA)</vote>, <vote slug="acute-pain-diclofenac-use">Acute musculoskeletal pain (FDA)</vote>, <vote slug="dysmenorrhea-use">Primary dysmenorrhea (FDA)</vote>, <vote slug="migraine-acute-diclofenac-use">Acute migraine (Cambia powder packet; FDA)</vote>, <vote slug="topical-oa-pain-use">Topical osteoarthritis pain in superficial joints (Voltaren gel, Pennsaid; FDA)</vote>, <vote slug="actinic-keratosis-use">Actinic keratosis (Solaraze 3% gel; FDA)</vote>

| starting_dose = IR oral 50 mg PO TID or 75 mg BID. Voltaren 1% gel: apply 2-4 g to affected area QID. Pennsaid 2%: 40 drops to knee BID. Flector patch: every 12 hours

| preparations = IR tablets 25, 50 mg; ER tablets 100 mg; Cataflam IR 50 mg; Zorvolex 18, 35 mg; Voltaren gel 1%; Pennsaid 2% topical solution; Flector transdermal patch; Solaraze 3% gel; Cambia oral powder 50 mg

| fda_max = 150 mg/day (oral); use lowest effective dose for shortest duration per FDA NSAID class guidance

| pill_id =

| routes = Oral, topical, transdermal, oral powder (Cambia for migraine)

| onset = 30-60 minutes (oral); slower for topical

| duration = 6-8 hours (IR oral); 12-24 hours (ER)

| halflife = 1-2 hours (parent compound)<ref name="voltaren-label">FDA Prescribing Information, Voltaren (diclofenac sodium), Novartis/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019201s041lbl.pdf</ref>

| bioavailability = ~50-60% (oral; substantial first-pass metabolism)<ref name="voltaren-label" />

| pregnancy = Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)<ref name="voltaren-label" />

| legal = [[USLegal:Prescription only|Rx-only]] for oral and most topical formulations in US; Voltaren Arthritis Pain 1% gel switched to [[USLegal:Over-the-counter|OTC]] in 2020

| mechanism = <vote slug="diclofenac-mech-claim">Non-selective COX-1/COX-2 inhibitor with slight COX-2 preference at therapeutic doses. Anti-inflammatory and analgesic effect from reduced prostaglandin synthesis. Among the higher-cardiovascular-risk NSAIDs per FDA's 2015 strengthened class warning, with the standard NSAID-class Boxed Warnings for cardiovascular thrombotic events and gastrointestinal bleeding.</vote> '''Hepatotoxicity signal''' is somewhat above average for the NSAID class, prompting periodic LFT monitoring with chronic use. Topical formulations achieve much lower systemic exposure with similar local analgesic effect, the basis of topical-first preference in elderly or comorbid patients<ref name="voltaren-label" />.

}}

== References ==

[[Category:NSAIDs]]

[[Category:Analgesics]]

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