diclofenac diethylammonium: clinical use

Prescribing considerations

• Confirm that symptoms fit a minor local musculoskeletal or non-serious arthritic condition.
• Consider cumulative NSAID exposure, especially with systemic NSAIDs.
• Systemic adverse effects remain possible with extensive or prolonged topical use.
• Use caution with current or previous peptic ulceration or asthma.
• Advise avoidance of damaged skin, mucous membranes, excessive sunlight and occlusive dressings.
• Warn about fire risk from gel-contaminated clothing, bedding and dressings.

Contraindications and cautions

• Hypersensitivity to diclofenac, aspirin, another NSAID or a formulation excipient
• Previous aspirin- or NSAID-triggered asthma, angioedema, urticaria or acute rhinitis
• Third trimester of pregnancy
• Children and adolescents under 14 years

Monitoring

• Assess response and reconsider the diagnosis if symptoms worsen or fail to improve.
• Monitor for local dermatitis, photosensitivity and hypersensitivity reactions.
• Remain alert to systemic NSAID effects with extensive or prolonged exposure.

Clinical pharmacology

Diclofenac inhibits cyclo-oxygenase and reduces prostaglandin synthesis. After topical application, approximately 6% of the applied amount was systemically absorbed in healthy-volunteer studies, with preferential distribution into deeper inflamed tissues.

Formulation and product differences

• The selected product is a white to practically white cream-like gel for cutaneous use.
• Diclofenac diethylammonium content corresponds to a lower amount of diclofenac sodium equivalent.
• Presentations may use tubes, a pump dispenser or a tube with an applicator cap; not every pack is necessarily marketed.
• The aqueous-alcoholic base can produce a cooling sensation.
• Propylene glycol and benzyl benzoate may cause local skin irritation.

Gel

Route: Cutaneous

Strengths: 1.16%, 2.32%