diclofenac sodium: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
diclofenac sodium: clinical details
Prescribing considerations
- Assess gastrointestinal, cardiovascular, renal, hepatic, respiratory, bleeding and interaction risks before systemic treatment.
- Review ongoing need and response, particularly in older or frail people and those with cardiovascular risk factors.
- Consider gastroprotection when gastrointestinal risk is increased.
- Avoid duplicate systemic NSAID therapy and reconcile non-prescription products.
- Topical exposure is lower, but systemic adverse effects remain possible with extensive or prolonged use.
Contraindications and cautions
- Hypersensitivity to diclofenac or an NSAID-triggered history of asthma, rhinitis, urticaria or angioedema.
- Active or recurrent gastrointestinal ulcer, bleeding or perforation, or previous NSAID-associated gastrointestinal bleeding or perforation.
- Established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or specified congestive heart failure for systemic formulations.
- Severe cardiac, renal or hepatic failure, subject to the individual product licence.
- Third trimester of pregnancy.
- For the selected gel: use below the licensed age, renal impairment, damaged skin and other product-specific exclusions.
Monitoring
- Consider blood pressure, renal function and fluid status in at-risk patients.
- Monitor for gastrointestinal bleeding, especially in older people or those with ulcer risk.
- During prolonged systemic treatment, monitor liver function and blood count.
- Monitor relevant clinical or laboratory parameters when indicated by interacting treatment.
Clinical pharmacology
Diclofenac is a phenylacetic-acid NSAID that inhibits cyclo-oxygenase and prostaglandin synthesis. It is highly protein-bound and extensively metabolised; topical application produces substantially lower plasma exposure than oral administration.
Formulation and product differences
- Prolonged- and modified-release oral forms provide extended release and must be swallowed whole.
- Suppositories provide rectal systemic delivery; licensed indications and paediatric suitability vary by preparation.
- Gel is for local treatment on intact skin and has lower systemic absorption, but its contraindications and licensed indications differ from systemic products.
- Excipients differ between products and may include lactose, sucrose, ethanol, propylene glycol or parabens.
diclofenac sodium preparations and strengths
Gel
Route: Cutaneous
Strengths: 1%, 3%
Modified-release tablet
Route: Oral
Strengths: 75 mg, 100 mg
diclofenac sodium interactions
Check all prescribed, pharmacy and herbal products, including combination cold and pain remedies.
Other NSAIDs, including ibuprofen, naproxen and anti-inflammatory doses of aspirin
Concurrent systemic use increases gastrointestinal and other NSAID adverse effects and should generally be avoided.
Anticoagulants and antiplatelet medicines
Bleeding risk can increase.
Corticosteroids or SSRI antidepressants
Gastrointestinal ulceration or bleeding may become more likely.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.