Diclofenac
VOLTAREN
Pronunciation: dye-KLOE-fen-ak
“Dick Loaf Voltron”
“The N said... NSAID”
What it isCOX-1 and COX-2 inhibitor with relative COX-2 preference; oral or topical treatment of arthritis and acute pain.
Why this oneIts topical formulation treats localized osteoarthritis with much less systemic exposure than oral diclofenac.
What limits itIts cardiovascular and hepatic risks are unusually prominent among traditional NSAIDs; it can also raise lithium exposure.
FDA-approved for
- pain/arthritis (1988)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Osteoarthritis | Adults | 50 mg BID–TID or 75 mg BID (100–150 mg/day) | 150 mg/day | |
| Rheumatoid arthritis | Adults | 50 mg TID–QID or 75 mg BID (150–200 mg/day) | 200 mg/day | |
| Ankylosing spondylitis | Adults | 25 mg QID plus 25 mg QHS if needed (100–125 mg/day) | 125 mg/day |
Renal Undefined
Hepatic Undefined
Instructions
- Use the lowest effective dose for the shortest duration consistent with treatment goals
- Different diclofenac formulations are not necessarily bioequivalent even at the same mg strength
Available strengths
- DR tab 25, 50, 75 mg
- cap 25 mg
- tab 25, 50 mg
- ER tab 100 mg
- drops 0.1 %
- sol 1.5, 2 %
- sol 50 mg
- gel 1, 3 %
- + 1 other marketed form not shown
Contraindications
- History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs
- In the setting of coronary artery bypass graft (CABG) surgery
Cautions
- Cardiovascular thrombotic events (MI, stroke)
- GI bleeding, ulceration, perforation
- Hepatotoxicity
- Hypertension, heart failure and edema
- Renal toxicity and hyperkalemia
- Anaphylactic reactions; serious skin reactions
- Hematologic toxicity/anemia
Adverse reactions
- Abdominal pain/dyspepsia
- Nausea
- Diarrhea
- Constipation, flatulence
- Headache, dizziness
- Edema
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 25 mg | DR tab | 60 BID | $41.06 | offered |
| 50 mg | DR tab | 60 BID | $3.74 | offered |
| 75 mg | DR tab | 60 BID | $3.72 | offered |
Other forms: Diclofenac oral solution (CAMBIA) · Diclofenac topical gel (VOLTAREN ARTHRITIS PAIN)
Generic entry2030 est.
⚠ BOXED WARNINGS
- Cardiovascular thrombotic events
- Gastrointestinal bleeding, ulceration and perforation
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.
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