Diclofenac
Diclofenac (sodium, potassium, epolamine; multiple salt forms)
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)
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Summary
Common uses
Osteoarthritis (FDA)0, Rheumatoid arthritis (FDA)0, Ankylosing spondylitis (FDA)0, Acute musculoskeletal pain (FDA)0, Primary dysmenorrhea (FDA)0, Acute migraine (Cambia powder packet; FDA)0, Topical osteoarthritis pain in superficial joints (Voltaren gel, Pennsaid; FDA)0, Actinic keratosis (Solaraze 3% gel; FDA)0
Pharmacy
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
US FDA Max
150 mg/day (oral); use lowest effective dose for shortest duration per FDA NSAID class guidance
Pharmacology
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)
Half-life
1-2 hours (parent compound)[1]
Bioavailability
~50-60% (oral; substantial first-pass metabolism)[1]
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)[1]
Legal status
Purported mechanism
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.0 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[1].
References
- ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Voltaren (diclofenac sodium), Novartis/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019201s041lbl.pdf