|Cataflam® Oral; Voltaren®
Ophthalmic; Voltaren® Oral; Voltaren-XR®
Novo-Difenac®-SR; Nu-Diclo; Voltaren
Diclofenac Potassium; Diclofenac Sodium|
Nonsteroidal Anti-Inflammatory Agent (NSAID)
Acute treatment of mild to moderate pain; acute and chronic treatment of
rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis; used for
juvenile rheumatoid arthritis, gout, dysmenorrhea; ophthalmic solution for
postoperative inflammation after cataract extraction
B (D in 3rd trimester)
Known hypersensitivity to diclofenac, any component, aspirin or other
nonsteroidal anti-inflammatory drugs (NSAIDs); porphyria
Use with caution in patients with congestive heart failure, dehydration,
hypertension, decreased renal or hepatic function, history of GI disease, or
those receiving anticoagulants
Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea
1% to 10%:
Cardiovascular: Angina pectoris, arrhythmias
Central nervous system: Dizziness, nervousness
Gastrointestinal: GI ulceration, vomiting
Genitourinary: Vaginal bleeding
<1%: Chest pain, congestive heart failure, hypertension, tachycardia,
convulsions, forgetfulness, mental depression, drowsiness, insomnia, urticaria,
exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome,
angioedema, stomatitis, cystitis, agranulocytosis, anemia, pancytopenia,
leukopenia, thrombocytopenia, hepatitis, peripheral neuropathy, trembling,
weakness, blurred vision, change in vision, decreased hearing, interstitial
nephritis, nephrotic syndrome, renal impairment, wheezing, laryngeal edema,
shortness of breath, epistaxis, anaphylaxis, diaphoresis (increased)
Symptoms of overdose include acute renal failure, vomiting, drowsiness,
Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is
primarily supportive and symptomatic. Fluid therapy is commonly effective in
managing the hypotension that may occur following an acute NSAID overdose,
except when this is due to an acute blood loss.
CYP2C8 and 2C9 enzyme substrate; CYP2C9 enzyme inhibitor
Increased toxicity of digoxin, methotrexate, cyclosporine, lithium, insulin,
sulfonylureas, potassium-sparing diuretics, aspirin
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme,
cyclo-oxygenase, which results in decreased formation of prostaglandin
Onset of action: Cataflam® has a more rapid onset of
action than does the sodium salt (Voltaren®), because it
is absorbed in the stomach instead of the duodenum
Protein binding: 99%
Metabolism: In the liver to inactive metabolites
Half-life: 2 hours
Time to peak serum concentration: Cataflam®: Within 1
hour; Voltaren®: Within 2 hours
Elimination: Primarily in urine
Analgesia: Starting dose: 50 mg 3 times/day
Rheumatoid arthritis: 150-200 mg/day in 2-4 divided doses (100 mg/day of
sustained release product)
Osteoarthritis: 100-150 mg/day in 2-3 divided doses (100-200 mg/day of
sustained release product)
Ankylosing spondylitis: 100-125 mg/day in 4-5 divided doses
Ophthalmic: Instill 1 drop into affected eye 4 times/day beginning 24 hours
after cataract surgery and continuing for 2 weeks
May be taken with food to decrease GI distress
Monitor CBC, liver enzymes; monitor urine output and BUN/serum creatinine in
patients receiving diuretics; occult blood loss
|Mental Health: Effects
on Mental Status|
May cause nervousness or dizziness; may rarely cause
Effects on Psychiatric
May rarely cause agranulocytosis; use caution with clozapine and
carbamazepine; may decrease the clearance of lithium resulting in elevated serum
levels and potential toxicity; monitor serum lithium levels
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
NSAID formulations are known to reversibly decrease platelet aggregation via
mechanisms different than observed with aspirin. The dentist should be aware of
the potential of abnormal coagulation. Caution should also be exercised in the
use of NSAIDs in patients already on anticoagulant therapy with drugs such as
Oral: Take this medication exactly as directed; do not increase dose without
consulting prescriber. Do not crush or chew tablets. Take with 8 ounces of
water, along with food or milk products to reduce GI distress. Maintain adequate
fluid intake (2-3 L/day of fluids unless instructed to restrict fluid intake).
Avoid excessive alcohol, aspirin and aspirin-containing medication, and all
other anti-inflammatory medications unless consulting prescriber. You may
experience dizziness, nervousness, or headache (use caution when driving or
engaging in tasks requiring alertness until response to drug is known); nausea,
vomiting, dry mouth, or heartburn (frequent small meals, frequent mouth care,
sucking lozenges, or chewing gum may help); or constipation (increased exercise,
fluids, or dietary fruit and fiber may help). GI bleeding, ulceration, or
perforation can occur with or without pain; discontinue medication and contact
prescriber if persistent abdominal pain or cramping, or blood in stool occurs.
Report chest pain or palpitations; breathlessness or difficulty breathing;
unusual bruising/bleeding or blood in urine, stool, mouth, or vomitus; unusual
fatigue; skin rash or itching; unusual weight gain or swelling of extremities;
change in urinary pattern; change in vision or hearing; or ringing in ears.
Pregnancy/breast-feeding precautions: Consult prescriber if pregnant or
Ophthalmic: For ophthalmic use only. Apply prescribed amount as often as
directed. Wash hands before using and do not let tip of applicator touch eye or
contaminate tip of applicator. Tilt head back and look upward. Gently pull down
lower lid and put drop(s) in inner corner of eye. Close eye and roll eyeball in
all directions. Do not blink for
minute. Apply gentle pressure to inner corner of eye for 30 seconds. Wipe away
excess from skin around eye. Do not use any other eye preparation for at least
10 minutes. Do not touch tip of applicator to eye or contaminate tip of
applicator. Do not share medication with anyone else. May cause sensitivity to
bright light (dark glasses may help); temporary stinging or blurred vision may
occur. Inform prescriber if you experience eye pain, redness, burning, watering,
dryness, double vision, puffiness around eye, vision disturbances, or other
adverse eye response; worsening of condition or lack of improvement. Consult
prescriber if pregnant or breast-feeding.
Do not crush tablets
Solution, ophthalmic, as sodium (Voltaren®): 0.1% (2.5
mL, 5 mL)
Tablet, enteric coated, as sodium: 25 mg, 50 mg, 75 mg
Voltaren®: 25 mg, 50 mg, 75 mg
Tablet, delayed release: 25 mg, 50 mg, 75 mg
Tablet, extended release, as sodium (Voltaren®-XR): 100
Tablet, as potassium (Cataflam®): 50 mg
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