Nonsteroidal Anti-Inflammatory Agent (NSAID)
Dental: Treatment of postoperative pain
Medical: Management of inflammatory disorders usually including rheumatoid
arthritis and osteoarthritis; can be used as an analgesic for treatment of mild
to moderate pain
C (1st and 2nd trimester); D (3rd trimester)
Hypersensitivity to diflunisal or any component, may be a cross-sensitivity
with other nonsteroidal anti-inflammatory agents including aspirin; should not
be used in patients with active GI bleeding
Peptic ulceration and GI bleeding have been reported; platelet function and
bleeding time are inhibited; ophthalmologic effects; impaired renal function,
use lower dosage; dehydration; peripheral edema; possibility of Reye's syndrome;
elevation in liver tests
Central nervous system: Headache
Endocrine & metabolic: Fluid retention
1% to 10%:
Cardiovascular: Angina pectoris, arrhythmias
Central nervous system: Dizziness
Gastrointestinal: GI ulceration
Genitourinary: Vaginal bleeding
<1%: Chest pain, vasculitis, tachycardia, convulsions, hallucinations,
mental depression, drowsiness, nervousness, insomnia, toxic epidermal
necrolysis, urticaria, exfoliative dermatitis, itching, erythema multiforme,
Stevens-Johnson syndrome, angioedema, stomatitis, esophagitis or gastritis,
cystitis, hemolytic anemia, agranulocytosis, thrombocytopenia, hepatitis,
peripheral neuropathy, trembling, weakness, blurred vision, change in vision,
decreased hearing, interstitial nephritis, nephrotic syndrome, renal impairment,
wheezing, shortness of breath, anaphylaxis, diaphoresis (increased)
Symptoms of overdose include drowsiness, nausea, vomiting, hyperventilation,
tachycardia, tinnitus, stupor, coma, renal failure, leukocytosis
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.
Decreased effect with antacids; ACE-inhibitor effects may be decreased by
concurrent therapy with NSAIDS
Increased effect/toxicity of digoxin, methotrexate, anticoagulants,
phenytoin, sulfonylureas, sulfonamides, lithium, indomethacin,
hydrochlorothiazide, acetaminophen (levels)
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme,
cyclo-oxygenase, which results in decreased formation of prostaglandin
Onset of analgesia: Within 1 hour
Duration of action: 8-12 hours
Absorption: Well absorbed from GI tract
Distribution: Appears in breast milk
Metabolism: Extensively in the liver
Half-life: 8-12 hours, prolonged with renal impairment
Time to peak serum concentration: Oral: Within 2-3 hours
Elimination: In urine within 72-96 hours, ~3% as unchanged drug and 90% as
Inflammatory condition: 500-1000 mg/day in 2 divided doses; maximum daily
dose: 1.5 g
Dosing adjustment in renal impairment: Clcr <50
mL/minute: Administer 50% of normal dose
Should be taken with food to decrease GI distress
Decrease in uric acid (S), increase in salicylate levels (S), increase in
|Mental Health: Effects
on Mental Status|
May cause dizziness; rarely may cause insomnia, nervousness, depression, and
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
If self-administered, use exactly as directed (do not increase dose or
frequency); adverse reactions can occur with overuse. Do not take longer than 3
days for fever, or 10 days for pain without consulting medical advisor. Take
with food or milk. While using this medication, do not use alcohol, excessive
amounts of vitamin C, or salicylate-containing foods (curry powder, prunes,
raisins, tea, or licorice), other prescription or OTC medications containing
aspirin or salicylate, or other NSAIDs without consulting prescriber. Maintain
adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid
intake). You may experience nausea, vomiting, gastric discomfort (frequent mouth
care, small frequent meals, chewing gum, or sucking lozenges may help). GI
bleeding, ulceration, or perforation can occur with or without pain. Stop taking
medication and report ringing in ears; persistent pain in stomach; unresolved
nausea or vomiting; difficulty breathing or shortness of breath; unusual
bruising or bleeding (mouth, urine, stool); skin rash; unusual swelling of
extremities; chest pain; or palpitations. Pregnancy/breast-feeding
precautions: Inform prescriber if you are or intend to be pregnant. Consult
prescriber if breast-feeding.
Do not crush tablet
Tablet: 250 mg, 500 mg
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N Engl J Med, 1998, 338(11):727-34.
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