Diclofenac Sodium

Diclofenac (中文: 雙氯芬酸)is an anti-steroidal antiinflammatory drug, an NSAID. As an NSAID, indomethacin is an analgesic, anti-inflammatory and antipyretic. It is used in musculoskeletal and joint disorders such as alkylosing spondylitis, osteoarthritis and rheumatoid arthritis including juvenile idiopathic arthritis. It is also used in dysmenorrhoea, headache including micraine, postoperative pain, soft-tissue disorders, acute gout, and to reduce fever. Eye drops of diclofenac sodium are used for the prevention of intra-operative miosis during cataract extraction, for the treatment of inflammation after surgery or laser treatment of the eye.

Pronunciation

Diclofenac sodium 100mg

Diclofenac sodium 25mg

Drug Names

Generic Name 藥名	HA Code 藥物代碼	Classification藥物分類
Diclofenac 25mg tablet	DICL01	P1S1S3
Diclofenac SR tab 100mg	DICL02	P1S1S3
Diclofenac injection 25/ml	DICL03	P1S1S3
Diclofenac rectal suppository 50mg	DICL011	P1S1S3

Mechanism of Action

Anti-inflammatory agent, Non-steroidal anti-inflammatory drug (NSAID) Non-selective COX inhibitor

Dosage

Oral	25 to 50 mg every 6 to 8 hours to a maximum of 150 mg daily
Deep intramuscular	75 mg once daily For severe conditions, 75 mg twice daily.
Bolus intravenous	75 mg may be given over 30 to 120 minutes. The dose may be repeated once after 4 to 6 hours if necessary.

Eye drops

Diclofenac sodium 0.1% eye drops is used in various situations:

• For the prevention of intra-operative miosis during cataract surgery. It is instilled in the appropriate eye 4 times during the 2 hours before surgery
• For the treatment of postoperative inflammation after cataract surgery. It is instilled 4 times daily for up to 28 days starting 24 hours after surgery
• For pain control after accidental trauma, one drop is instilled 4 times daily for up to 2 days
• To relieve symptoms of seasonal allergic conjunctivitis, one drop is instilled 4 times daily as necessary

Topical

Diclofenac dimethylamine is used topically as a gel for the local symptomatic relief of pain and inflammation. It is applied to the affected site 3 or 4 times daily.

Administration in children

For children aged 6 months to 17 years

rheumatic disease	Oral: 3 to 5 mg/kg daily in 2 or 3 divided doses
soft-tissue disorders	Oral: 0.3 to 1 mg/kg (maximum 50 mg) given 3 times daily.
Rectal	For 8 to 11 kg, 12.5 mg twice daily and heavier children 1 mg/kg three times daily
Intravenous infusion or deep intramuscular injection	0.3 to 1 mg/kg (maximum 50 mg) given 3 times daily, for up to 2 days for postoperative pain.

Regardless of route or indication, a maximum daily dose of 150 mg should not exceeded.

Side Effects

As for NSAIDs in general.

Common side effects	Heartburn, nausea, dyspepsia, diarrhoea, constipation, gastrointestinal ulceration/bleeding, headache, dizziness, rash, salt and fluid retention, and high blood pressure.

It also increases the risk of heart attack, stroke, kidney failure and liver failure.

Diclofenac suppositories	Can cause local irritation
Diclofenac eye drops	Transient burning and stinging may occur
Effects on the blood	Localized spontaneous bleeding, bruising and prolonged bleeding time have been reported
Diclofenac such as plasters and gel	May cause application site reactions
Asthma	Can be worsen
Cardiovascular risk	Chronic ibuprofen use has been found correlated with risk of progression to hypertension and myocardial infarction (heart attack). Both the U.S. Food and Drug Administration (FDA) and The European Medicines Agency (EMA) issues warnings of increased heart attack and stroke risk.
Skin	NSAIDs have been associated with the onset of bullous pemphigoid. It can also cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, which can be fatal.

Pharmacokinetics

Diclofenac is rapidly absorbed when given as an oral solution, tablet or rectal suppository, or by intramuscular injection.

It is subject to first-pass metabolism so that about 50% of the drug reaches the systemic circulation in the unchanged form.

Diclofenac is also absorbed percutaneously.

At therapeutic concentrations it is more than 99% bound to plasma proteins.

Diclofenac penetrates synovial fluid where concentrations may persist even when plasma concentrations fall; small amounts are distributed into breast milk.

The terminal plasma half-life is about 1 to 2 hours.

It is excreted mainly in the urine (about 60%) but also in the bile (about 35%); less than 1% is excreted as unchanged diclofenac.

Drug Management

Monitoring

Efficiency : Pain and inflammation control

Safety : Monitor signs of bleeding and bruising, and blood pressure.

Drug Interaction

Interactions involving NSAIDs include

• enhancement of the effects of oral anticoagulants
• increased plasma concentrations of lithium, methotrexate and cardiac glycosides.
• Risk of nephrotoxicity may be increased if given with ACE inhibitors, ciclosporin, tacrolimus or diuretics
• Antihypertensive effects of ACEIs, beta blockers and diuretics may be reduced
• Use of more than one NSAID together (including aspirin) should be avoided because of the increased risk of adverse effects.
• The risk of gastrointestinal bleeding and ulceration is increased when used with steroids, the SSRIs, the SNRI venlafaxaine, the antiplatelet clopidogrel, bisphosphonates or pentoxifylline.

Co-adminstration of ACE inhibitor can increase risk of kidney problem and increase hypotensive effect. Aspirin.

Caution

• Allergic reaction,
• Previous peptic ucler
• uncontrolled hypertension,
• Impaired renal function

Contraindication

• Hypersensitivity against diclofenac
• History of allergic reactions (bronchospasm, rhinitis, urticaria) following the use of other NSAIDs such as aspirin
• Third-trimester pregnancy
• Active stomach and/or duodenal ulceration or gastrointestinal bleeding
• Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• Severe congestive heart failure (NYHA III/IV)
• Severe liver insufficiency
• Severe chronic kidney disease (creatinine clearance <30 mi/min)
• Caution in patients with pre-existing hepatic porphyria, as diclofenac may trigger attacks
• Caution in patients with severe, active bleeding such as cerebral hemorrhage
• Caution in patients with fluid retention or heart failure
• Can lead to onset of new hypertension or worsening of pre-existing hypertension
• Should not be given intravenously to patients with asthma

FAQ

How should I take the tablet?

Follow the doctor's prescription Take with food if diclofenac upsets your stomach.

What should I avoid while taking?

Avoid alcohol consumption.

What happen if I overdose?

Contact your primary care doctor. If emergency situation, call 999

What happen if I miss a dose?

Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.