Diflunisal

DOLOBID

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Pronunciation: dye-FLOO-ni-sal

Diflunisal ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Diflunisal ballicule

Diflunisal DOLOBID mascot mnemonic cartoon — Visual mnemonic: Diflunisal mascot
**“Different looney Dollar bids”**
“The N said... NSAID”
Dosed BID, as the name suggests

What it isSalicylate-derived COX-1/COX-2 inhibitor; arthritis and mild-to-moderate pain.

Why this oneIts long duration distinguishes it from aspirin without aspirin’s irreversible platelet effect.

What limits itGI bleeding, kidney injury, and cardiovascular events remain; tinnitus can occur, and lithium levels rise.

Diflunisal molecular structure (skeletal formula) — Molecular structure: Diflunisal

FDA-approved for

osteoarthritis, rheumatoid arthritis and mild-to-moderate pain

FDA label

Read the full label on DailyMed ↗

BOXED WARNING NSAID: increased risk of serious CV thrombotic events (MI, stroke) — contraindicated peri-CABG; and serious GI bleeding, ulceration, and perforation.

FDA dosing	Population	Start	Target	Max
Mild to moderate pain	Adults	1,000 mg once, then 500 mg q12h (some patients 500 mg q8h; lower-dose option 500 mg then 250 mg q8–12h)	500 mg q12h	1,500 mg/day
Osteoarthritis / rheumatoid arthritis	Adults	500–1,000 mg/day in two divided doses	500–1,000 mg/day divided BID	1,500 mg/day

Renal Undefined

Hepatic Undefined

Maintenance doses above 1,500 mg/day are not recommended; concentration-dependent kinetics — doubling the dose more than doubles accumulation.

Instructions

Use the lowest effective dose for the shortest duration consistent with treatment goals
Swallow tablets whole; do not crush or chew
Avoid use in pregnancy at about 30 weeks gestation and later

Available strengths

tab 250, 375, 500 mg

Contraindications

Coronary artery bypass graft (CABG) surgery setting
Asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs

Cautions

Cardiovascular thrombotic events (MI, stroke)
Serious GI bleeding, ulceration, and perforation (may occur without warning; elderly at greater risk)
Anaphylactic/anaphylactoid reactions; caution with preexisting asthma
Fetal toxicity (premature ductus closure; oligohydramnios/neonatal renal impairment)
Serious skin reactions (exfoliative dermatitis, SJS, TEN, fixed drug eruption)

Adverse reactions

Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence
Somnolence, insomnia
Dizziness
Tinnitus
Rash
Headache, fatigue

Pregnancy Avoid at ≈30 weeks gestation and later (premature ductus arteriosus closure); use at ≈20 weeks or later may cause oligohydramnios/neonatal renal impairment.

Lactation Undefined

Cost

Diflunisal (DOLOBID)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
250 mg	tab	60 BID		not offered
375 mg	tab	60 BID		not offered
500 mg	tab	60 BID	$63.87	offered

Generic entry1992

⚠ BOXED WARNINGS

Cardiovascular thrombotic events
Gastrointestinal bleeding, ulceration and perforation

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

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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Memory aids: interaction avatars

Box: minimal PK interactions

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