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Oligohydramnios is often, but not always, reversible with treatment discontinuation. (Accessed 2009 Dec 14. Torri G. Efficacy and tolerability of aceclofenac in the treatment of gonalgia: controlled double-blind study vs diclofenac. Factors affecting the pharmacokinetics of diclofenac sodium (Voltarol). 1986; 40:876- 82. Wasner CK. Diclofenac gel for osteoarthritis. 1986; 292:237-8. http://www.ncbi.nlm.nih.gov/pubmed/3081085?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1339208&blobtype=pdf. © Copyright 2021, Selected Revisions November 9, 2020. Renal syndromes associated with nonsteroidal antiinflammatory drugs. 1987; 76:48-52. http://www.ncbi.nlm.nih.gov/pubmed/3585723?dopt=AbstractPlus. 1985; 40:784-6. Οργανοφωσφορικό διασυστηματικό εντομοκτόνο επαφής και στομάχου. Trelle S, Reichenbach S, Wandel S et al. Food and Drug Administration. Use of diclofenac in analgesia. 188. 1983; 8:350-3. http://www.ncbi.nlm.nih.gov/pubmed/6340976?dopt=AbstractPlus, 135. Diclophenac sodium, oxyphenbutazone and placebo in sports injuries of the knee. Voltaren (diclofenac sodium 1%) topical gel prescribing information. 76. Clinical implications of prostaglandin and thromboxane A2 formation (second of two parts). 113. (Spanish; with English abstract.) Beun GDM, Leunissen KML, Van Breda Vriesman PJC et al. Diclofenac sodium, a negative chemokinetic factor for neutrophil locomotion. Absorption and effect of diclofenac-sodium after surgical removal of a lower wisdom tooth. 1988; 30:919-21. 317. Searle. Circulation. Breitner JCS, Zandi PP. Am J Sports Med. 2002; 347:2104-10. http://www.ncbi.nlm.nih.gov/pubmed/12501222?dopt=AbstractPlus. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. 3. Antipyretic therapy with diclofenac sodium. Isolated minimal change nephropathy associated with diclofenac. Neurology. Synovial fluid concentrations of diclofenac in patients with rheumatoid arthritis or osteoarthritis. There are 3 accepted formulas used to determine how much Lasix to administer to any given patient: The House of God Lasix Formula - Law VII states that age + BUN = Lasix dose. 1988; 47:791. http://www.ncbi.nlm.nih.gov/pubmed/3178321?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1003601&blobtype=pdf, 210. 3rd ed. Schapira D, Bassan L, Nahir AM et al. Efficacy and safety of diclofenac compared with aspirin in the treatment of rheumatoid arthritis. 1986; 80(Suppl 4B):18-23. http://www.ncbi.nlm.nih.gov/pubmed/3085488?dopt=AbstractPlus, 24. We comply with the HONcode standard for trustworthy health information -. Eidsaunet W, Borkje B, Larsen S et al. Verstraeten A, Bakshi R. Diclofenac potassium for the treatment of traumatic joint distortions: an open multicentre study. O’Brien WM. 111. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. Anon. Anon. Am J Med. 1979; 4:153-62. Inhibition of prostaglandin biosynthesis by non-narcotic analgesic drugs. NSAIDs, Helicobacter pylori, and Pandora’s box. Antimicrob Agents Chemother. 204. Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. 2001; 345:1809-17. http://www.ncbi.nlm.nih.gov/pubmed/11752357?dopt=AbstractPlus. Dapas F (Geigy, Ardsley, NY): Personal communication; 1989 Jul. Plant Remedies Private Limited - Offering Rogor Plus Acaricide, यूकानाशी, Insecticides & Acaricides in Jamal Road, Patna, Bihar. Faigle JW, Böttcher I, Godbillon J et al. Tonachella R, Curcio CG, Grossi E. Diclofenac sodium in cancer pain: a double-blind within-patients comparison with pentazocine. Eur J Clin Pharmacol. Biochem Pharmacol. Ottobratica) from an Agusta Bell 47 G 2 fitted with a Vapo 54 spraying system … 1986; 31:363-5. http://www.ncbi.nlm.nih.gov/pubmed/3792436?dopt=AbstractPlus, 179. 1986; 80(Suppl 4B):70-80. St. Louis: JB Lippincott Co; 1988(Apr):458,459,463,464. Geigy Pharmaceuticals. Jpn J Ophthalmol. E Afr Med J. Scand J Haematol. NSAIDs and incident Alzheimer’s disease: the Rotterdam Study. 283. Scharf Y, Nahir M, Schapira D et al. Chan KKH, Vyas KH, Brandt KD. Does the drug diclofenac have narcotics in it? 1996; 384:644-8. http://www.ncbi.nlm.nih.gov/pubmed/8967954?dopt=AbstractPlus, 287. Mayo Clin Proc. Central and peripheral analgesic action of aspirin-like drugs. Lanza FL, and the members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Michalevicz R, Seligsohn U. Philadelphia: Lea & Febiger; 1989:503-30. Fowler PD, Dawes PT, John VA et al. 1986; 40:576-86. 1993; 19:5991. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name, Tablets, delayed-release (enteric-coated), Diclofenac Sodium Delayed-release Tablets, Diclofenac Sodium Extended Release Tablets, Tablets, delayed-release (enteric-coated core), film-coated, 50 mg diclofenac sodium enteric-coated core, with 200 mcg of misoprostol outer layer*, Diclofenac Sodium and Misoprostol Delayed-release Tablets, 75 mg diclofenac sodium enteric-coated core, with 200 mcg of misoprostol outer layer*. Montvale, NJ: Medical Economics Company Inc; 1999:2013-5. Med Lett Drugs Ther. Am J Med. Clin Exp Rheumatol. Curr Ther Res. Arch Int Pharmacodyn Ther. Scott SJ, Bussey RA et al. 1985; 7:79-83. http://www.ncbi.nlm.nih.gov/pubmed/4008177?dopt=AbstractPlus. Rogor is a contact & systemic organophosphate insecticide providing quick knockdown used to manage insect pests such as bug, stem borer, shoot fly, aphids, thrips, beetles etc. Last updated on Nov 9, 2020. Zandstra DF, Stoutenbeek CP, Alexander JP. A new metabolite of diclofenac sodium in human plasma. of Rogor L 30 were applied to 3 plots of 10 ha. 1980; 19:193-8. http://www.ncbi.nlm.nih.gov/pubmed/6997973?dopt=AbstractPlus. Scand J Rheumatol. 302. Lizarazo PH, Cortes MP. 233. 39. 238. Spontaneous platelet aggregation after diclofenac treatment. Ehsanullah RS, Page MC, Tildesley G et al. Harkönen M, Ekblom-Kullberg S. Reversible deterioration of renal function after diclofenac in patient receiving triamterene. In: Kass, ed. J Int Med Res. These labels already warn to avoid using NSAIDs during the last 3 months of pregnancy because the medicines may cause problems in the unborn child or complications during delivery. 73. 137. 1980; 28:359-66. NSAIDs: time to re-evaluate gut toxicity. Chicago: American Medical Association; 1983:107-38. Batch Number 260702. 66. Philip PJ, Lema LEK, Carneiro PMR. Mazeika PK, Ford MJ. Ibuprofen- associated aseptic meningitis in systemic lupus erythematosus. Court H, Volans GN. 1998; 19:607-11. http://www.ncbi.nlm.nih.gov/pubmed/10192221?dopt=AbstractPlus, 299. Postgrad Med. West J Med. 209. Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. 242. Vandenburg MJ, Currie WJC, Mann SG et al. 1983; 25:389-94. http://www.ncbi.nlm.nih.gov/pubmed/6628528?dopt=AbstractPlus, 69. Garcia Rodriguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Flector (diclofenac epolamine) topical patch prescribing information. Lundstam S, Ivarsson L, Lindblad L. Diclofenac compared with a narcotic analgesic in the treatment of biliary pain. Evaluations of drug interactions. Rogor 30% EC - 100ml. J Int Med Res. Brater DC. Gislason GH, Rasmussen JN, Abildstrom SZ et al. Llorca G, Larbre JP, Collet P et al. 1978; 53:39-48. http://www.ncbi.nlm.nih.gov/pubmed/310771?dopt=AbstractPlus. Curr Ther Res. Arthritis Rheum. Seishin Igaku. 2000; 19:287-94. http://www.ncbi.nlm.nih.gov/pubmed/10799795?dopt=AbstractPlus. Rogor can be used for both indoor and outdoor purposes to eliminate a number of insects and pests such as Aphids Thrips Mites and White flies from damaging your crops.It is specifically used to preserve the freshness and quality of various crops like … Eur J Obstet Gynecol Reprod Biol. Aylward M, Maddock J, Lewis PA et al. Medically reviewed by Drugs.com. 250. Fatal hepatitis associated with diclofenac. Structural basis for selective inhibition of cyclooxygenase-2 by anti-inflammatory agents. 1980; 2:421-6. Pharmacokinetics and metabolism of the anti- inflammatory agent Voltaren. Novartis Consumer Health. Salicylates: molecular mechanism of therapeutic action. 96. ; The Cr40 Formula - This formula states that creatinine x 40 = Lasix dose. 322. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J et al. Stevenson DD. 1980; 8:167-74. http://www.ncbi.nlm.nih.gov/pubmed/6989687?dopt=AbstractPlus, 86. 40. Caldwell JR. Efficacy and safety of diclofenac sodium in rheumatoid arthritis: experience in the United States. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Diclofenac-containing_medicinal_products/European_Commission_final_decision/WC500155819.pdf, Other brands: Voltaren, Cataflam, Cambia, Zorvolex, ... +2 more, aspirin, prednisone, acetaminophen, tramadol, ibuprofen, meloxicam, cyclobenzaprine, duloxetine, Tylenol, Cymbalta. FDA briefing document: Joint meeting of the arthritis advisory committee and the drug safety and risk management advisory committee, February 10-11, 2014. Oradell, NJ: Medical Economics Company, Inc; 1989:2051-2. Il est possible que pour certains produits et dans certaines conditions, la quantité conseillée soit inexacte. Stein G, Robertson M, Nadarajah J. The First Aid Directions should read: If … 1986; 27:1390-3. http://www.ncbi.nlm.nih.gov/pubmed/3792922?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1434053&blobtype=pdf. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Reversible acute renal failure from combined triamterene and indomethacin. Am J Nephrol. Diclophenac sodium (Voltaren) in rheumatoid arthritis: a double-blind comparison with indomethacin and placebo. Pediatrics. 1983; 9:21-3. http://www.ncbi.nlm.nih.gov/pubmed/6833624?dopt=AbstractPlus. Bernheim HA, Block LH, Atkins E. Fever: pathogenesis, pathophysiology, and purpose. Dimethoate is a widely used organophosphate insecticide and acaricide.It was patented and introduced in the 1950s by American Cyanamid.Like other organophosphates, dimethoate is an acetylcholinesterase inhibitor which disables cholinesterase, an enzyme essential for central nervous system function. 182. The comparative gastric ulcerogenic activities of non-steroid anti-inflammatory drugs. 1978; 53:442-5. http://www.ncbi.nlm.nih.gov/pubmed/354028?dopt=AbstractPlus. 1979; 91:261-70. http://www.ncbi.nlm.nih.gov/pubmed/223485?dopt=AbstractPlus, 194. Treat Guidel Med Lett. Whitehouse Station, NJ; 2006 Feb. 316. Eur J Pharmacol. Calabro JJ, Ehrlich GE. (German; with English abstract.) Widener HL, Littman BH. Cheminova Insecticide Rogor. Khalil H, Molinary E, Stoller JK. 1983; 10:26-31. Acta Haematol. 10th ed. Προορίζεται μόνο για επαγγελματίες χρήστες. 1982; 245:67-68. 1985; 4:267-77. http://www.ncbi.nlm.nih.gov/pubmed/3905218?dopt=AbstractPlus, 110. Clin Rheum Dis. Présence du diclofénac dans le plasma et le liquide synovial au cours de diverses affections rhumatismales. FDA Drug Bull. PRA No. Am J Med. 1987; 31:553-7. http://www.ncbi.nlm.nih.gov/pubmed/3549320?dopt=AbstractPlus, 174. Agents Actions. Introduction. Famaey JP, Ginsberg F. Treatment of periarthritis of the shoulder: a comparison of ibuprofen and diclofenac. Role and regulation of cyclooxygenase-2 during inflammation. Eur J Clin Pharmacol. 1978; 22(Suppl):5-16. Am J Med. A comparative study of piroxicam (Feldene) diclofenac and placebo in osteoarthritis. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Singh G, Triadafilopoulos G. Epidemiology of NSAID induced gastrointestinal complications. Am J Med. 87. Harima Y, Maekawa T, Miyauchi Y et al. For prescription NSAIDs, FDA is requiring changes to the prescribing information to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. Circulation. 1999; 94:504-8. http://www.ncbi.nlm.nih.gov/pubmed/10511349?dopt=AbstractPlus, 292. ), Apply 1 transdermal system (diclofenac epolamine 1.3%) twice daily.317, Some authorities (e.g., Health Canada) state that a total dose of 200 mg may be administered on the first day of treatment for dysmenorrhea but subsequent dosage should not exceed 100 mg daily.520 (See Cardiovascular Thrombotic Effects under Cautions. Int J Tissue React. 291. 2004; 126(Suppl):401S-28S. 1986; 80(Suppl 4B):81-7. http://www.ncbi.nlm.nih.gov/pubmed/3518436?dopt=AbstractPlus. Gaz Med Fr. Am J Med. New York, NY; 2006 Mar. Grossi E, Broggini M, Quaranta M et al. Giorn Chir. Analysis and recommendations for agency action regarding non-steroidal anti-inflammatory drugs and cardiovascular risk. Food and Drug Administration. Perianin A, Gougerot-Pocidalo MA, Giroud JP et al. Benson MD, Aldo-Benson M, Brandt KD. Rheumatol Rehabil. Rogor is a systemic insecticide with the added advantage of contact action to give rapid kill of insect pests hit by the spray at the time of application. 2013; 8:e54309. Prostaglandins. Curr Ther Res. In experimental olive fly control conducted in 1968 in collaboration with the Phytopathological Institute of Catanzaro (CIGLIANO, 1969) doses of 1.5, 2 and 3 kg./ha. 1986; 8:427-38. http://www.ncbi.nlm.nih.gov/pubmed/3524843?dopt=AbstractPlus, 118. Fowler PD. 6. Clin Rheum. 1986; 80(Suppl 4B):64-9. http://www.ncbi.nlm.nih.gov/pubmed/2939715?dopt=AbstractPlus, 93. 1985; 4:166-70. 74. AMA Department of Drugs. 2001; 345:1515-21. http://www.ncbi.nlm.nih.gov/pubmed/11794217?dopt=AbstractPlus. Can NSAIDs be used to treat a COVID-19 fever? Curr Med Res Opin. Drugs. Seppala E, Nissila M, Isomaki H et al. 1984; 73:431-3. http://www.ncbi.nlm.nih.gov/pubmed/6423718?dopt=AbstractPlus, 145. 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Acidity constants of sparingly water-soluble drugs from potentiometric determinations in aqueous dimethyl sulfoxide. † Use is not currently included in the labeling approved by the US Food and Drug Administration. McCarthy JT, Torres VE, Romero JC et al. The influence of food on the absorption of diclofenac as determined by the urinary excretion of the unchanged drug and its major metabolites during chronic administration. 1997; 75:1088-95. http://www.ncbi.nlm.nih.gov/pubmed/9365818?dopt=AbstractPlus. Scand J Rheumatol. Diovan (valsartan) capsules prescribing information (dated 1997 Apr). 185. 1999; 106(Suppl 5B):37-42S. Eur J Anaesth. Health Canada. are used to treat medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. Diclofenac versus dipyrone in acute renal colic: a double-blind controlled trial. 99. 243. Kirchheiner B, Trang L, Wollheim FA. Copyright @ 2014-15 farmguru.in. 5th ed. Bonfiglioli D, Sommariva D, Zanaboni L et al. 199. Bird HA, Hill J, Letham P et al. Friman C, Johnston C, Chew C et al. 2011; 342:c7086. 105. As currently described in the NSAID labels, avoid prescribing NSAIDs at 30 weeks and later in pregnancy because of the additional risk of premature closure of the fetal ductus arteriosus. Ultrastructural and functional studies on human platelets incubated with diclofenac sodium (Voltaren). Erythema multiforme major following use of diclofenac. Can be used over a large number of crops for many insects. 5. 2013; 62:e147-239. 1985; 17:679-84. http://www.ncbi.nlm.nih.gov/pubmed/2931730?dopt=AbstractPlus, 31. Kearney PM, Baigent C, Godwin J et al. 1979; 9:611-21. http://www.ncbi.nlm.nih.gov/pubmed/119353?dopt=AbstractPlus. Zuckner J. 9. 151. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. New York; Macmillan Publishing Company; 1985; 660- 73. 1988 Oct. 198. 1991; 19:121-30. http://www.ncbi.nlm.nih.gov/pubmed/1864448?dopt=AbstractPlus, 278. 41. ), Anaphylactoid reactions (e.g., anaphylaxis, angioedema) reported.1 302 303 317 318, Immediate medical intervention and discontinuance for anaphylaxis.1 302 303 317 318, Avoid in patients with aspirin triad (aspirin sensitivity, asthma, nasal polyps); caution in patients with asthma.1 302 303 317 318, Serious skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) reported; can occur without warning.1 302 303 317 318 Discontinue at first appearance of rash or any other sign of hypersensitivity (e.g., blisters, fever, pruritus).1 302 303 317 318, Do not use multiple diclofenac-containing preparations concomitantly.1 302 303 Concomitant use of diclofenac sodium 1% gel and oral NSAIAs may increase risk of adverse effects.318, Observe the usual cautions, precautions, and contraindications associated with misoprostol therapy when diclofenac is used in fixed combination with misoprostol.284, Severe, sometimes fatal, reactions including jaundice, fulminant hepatitis, liver necrosis, and hepatic failure reported rarely with diclofenac.1 302 303 317 318 323, Elevations of serum ALT or AST reported.1 302 303 317 318 323, Monitor for symptoms and/or signs suggesting liver dysfunction.1 302 303 317 318 323 Obtain serum transaminase values 4–8 weeks after initiating therapy; monitor periodically during long-term therapy.317 318 323 ALT (SGPT) is the recommended hepatic function marker for monitoring liver injury.317 318 323, Discontinue if abnormal liver function test results persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g., eosinophilia, rash).1 164 255 302 303 317 318 323, Anemia reported rarely.1 302 303 317 318 Determine hemoglobin concentration or hematocrit in patients receiving long-term therapy if signs or symptoms of anemia occur.1 248 302 303 317 318, May inhibit platelet aggregation and prolong bleeding time.3 40 41 42 43 165 166, Minimize or avoid exposure of treated areas to natural or artificial sunlight.318 Topical application of diclofenac gel formulations has resulted in early onset of ultraviolet (UV) light-related skin tumors in animal studies.318 321 The potential effects of topical diclofenac gel on skin response to UV damage in humans are not known.318, Application to nonintact skin may alter absorption and tolerability; apply only to intact skin.318, Avoid contact with the eyes and mucous membranes.318 If contact with the eyes occurs, thoroughly rinse the eyes with water or saline.318 If ocular irritation persists for >1 hour, consult a clinician.318, Avoid contact with eyes and mucous membranes.317 If contact with the eyes occurs, thoroughly rinse the eyes with water or saline.317 If ocular irritation persists for >1 hour, consult a clinician.317, Do not apply to nonintact or damaged skin.317, Patient should bathe or shower after removing one transdermal system and before applying a new system; the transdermal system should not be worn during bathing or showering.317, Store and discard transdermal systems in a manner that avoids accidental exposure or ingestion by children or pets.317, Not a substitute for corticosteroid therapy; not effective in the management of adrenal insufficiency.1 248 302 303 317 318, May mask certain signs of infection.1 302 303 317 318, Obtain CBC and chemistry profile periodically during long-term use.1 302 303 317 318, Category C.1 302 303 317 318 Avoid use in third trimester because of possible premature closure of the ductus arteriosus.1 302 303 317 318, Category X (in fixed combination with misoprostol).284 Misoprostol exhibits abortifacient activity and can cause serious fetal harm.284, Distributed into milk; 3 discontinue nursing or the drug.1 302 303 317 318, Safety and efficacy not established in children.1 302 303 317 318, Good results with oral diclofenac obtained in a limited number of children 3–16 years of age for the management of juvenile rheumatoid arthritis†.3 128 210, Oral diclofenac: Caution advised.1 302 303 Fatal adverse GI effects reported more frequently in geriatric patients than younger adults.1 302 303 317 318, Diclofenac sodium 1% gel: No substantial difference in safety and efficacy in individuals ≥65 years of age compared with younger individuals; possibility of greater sensitivity to the drug in some geriatric individuals.318, Diclofenac epolamine transdermal system: Insufficient experience in individuals ≥65 years of age to determine whether geriatric patients respond differently than younger individuals.317, Use diclofenac with caution because of age-related decreases in renal function.317 318 May be useful to monitor renal function.317 318, Metabolites eliminated principally via the kidney.1 302 303, Use with caution in patients with renal disease.1 302 303 317 318 Use not recommended in patients with advanced renal disease; close monitoring of renal function advised if used.1 248 302 303 304 317 318, Oral diclofenac: Abdominal pain or cramps,1 75 86 93 107 113 136 302 303 constipation,1 75 113 132 134 136 302 303 diarrhea,1 84 86 87 93 95 125 134 302 303 flatulence,1 302 303 GI bleeding,1 302 303 GI perforation, 1 302 303 peptic ulcer,1 302 303 vomiting, 1 302 303 dyspepsia,1 302 303 nausea,1 76 78 84 85 93 95 96 97 98 99 109 111 113 126 129 134 165 302 303 dizziness,1 102 107 113 125 129 165 302 303 headache,1 89 90 91 93 95 107 110 113 118 125 127 129 132 165 302 303 liver function test abnormalities,1 116 125 165 189 209 223 255 302 303 renal function abnormalities,1 302 303 anemia,1 302 303 prolonged bleeding time,1 302 303 pruritus,1 302 303 rash,1 302 303 tinnitus,1 302 303 edema.1 109 125 132 159 165 302 303, Diclofenac sodium 1% gel: Application site reactions (e.g., dermatitis).318, Diclofenac epolamine transdermal system: Application site reactions (e.g., pruritus, dermatitis), nausea, altered taste.317, Only minimally displaces other highly protein-bound drugs from binding sites; however, may be displaced from binding sites by other highly protein-bound drugs.51 52 59 61, Reduced BP response to ACE inhibitor1 248 302 303 317 318, Possible deterioration of renal function in individuals with renal impairment315, Reduced BP response to angiotensin II receptor antagonist315, Antacids (magnesium- or aluminum-containing), Possible bleeding complications1 302 303 317 318, Decreased peak plasma concentration and AUC of diclofenac;22 61 184 202 302 303 limited data indicate that diclofenac does not inhibit antiplatelet effect of aspirin262, Increased risk of GI ulceration and other complications1 302 303 317 318, No consistent evidence that low-dose aspirin mitigates the increased risk of serious cardiovascular events associated with NSAIAs305 317 318 502 508, Manufacturer states that concomitant use not recommended1 302 303 317 318, Possible increase in nephrotoxic effects of cyclosporine1 302 303 318, Reduced natriuretic effects1 22 179 302 303 317 318, Monitor for diuretic efficacy and renal failure1 302 303 317 318, Increased plasma lithium concentrations1 176 188 265 302 303 317 318, Monitor for lithium toxicity1 302 303 317 318, Severe, sometimes fatal toxicity associated with increased plasma methotrexate concentrations175 307, Possible increased risk of seizures183 197 198, Well absorbed following oral administration.1 3 51 52 53 57 68 189 302 303 Undergoes first-pass metabolism; only 50–60% of a dose reaches systemic circulation as unchanged drug.1 52 53 73 284 302 303, Peak plasma concentration usually attained within about 1 hour (diclofenac potassium conventional tablets), 2 hours (diclofenac sodium delayed-release tablets), or 5.25 hours (diclofenac sodium extended-release tablets).1 3 51 52 302 303 307, Absorbed into systemic circulation following topical administration as gel or transdermal system; plasma concentrations generally very low compared with oral administration.3 227 317 318, Following application of a single diclofenac epolamine transdermal system to intact skin on the upper arm, peak plasma concentrations occur in 10–20 hours.317, Following topical application of diclofenac sodium 1% gel, peak plasma concentrations occur in about 10–14 hours.318, Moderate exercise does not alter systemic absorption of topically applied diclofenac (transdermal system or 1% gel).317 318, Application of a heat patch for 15 minutes before application of the 1% gel did not affect systemic absorption.318 Not established whether application of heat following gel application affects systemic absorption.318, Single 50- or 100-mg doses of diclofenac potassium provide pain relief within 30 minutes.307, Pain relief lasts up to 8 hours following administration of single 50- or 100-mg doses of diclofenac potassium.307, Food delays time to reach peak plasma concentration but does not affect extent of absorption following administration as conventional, delayed-release, or extended-release tablets.1 302 303, Following oral administration, concentrations in synovial fluid may exceed those in plasma.1 3 62 63 64 65 66 67 68 69 302 303, Metabolized in the liver via hydroxylation and conjugation.1 3 51 52 68 70 302 303 Some metabolites may exhibit anti-inflammatory activity.1 3 22 302 303, Excreted in urine (65%) and in feces via biliary elimination (35%) as metabolites.1 3 51 55 56 70 71 302 303, Oral preparations: 1–2 hours.2 53 57 60 302 303, Diclofenac epolamine transdermal system: Approximately 12 hours.317, In geriatric patients, pharmacokinetic profile similar to that in younger adults.307, In patients with renal impairment, plasma clearance not substantially altered,1 3 208 302 303 although clearance of metabolites may be decreased.3 72, 25°C (may be exposed to 15–30°C).318 Do not freeze.318, Inhibits cyclooxygenase-1 (COX-1) and COX-2.285 286 287 288 289 290, Pharmacologic actions similar to those of other prototypical NSAIAs;1 3 20 21 22 23 24 25 26 189 302 303 317 318 exhibits anti-inflammatory, analgesic, and antipyretic activity.1 3 21 22 23 189 302 303 317 318, Importance of reading the medication guide for NSAIAs that is provided each time the drug is dispensed.1 302 303 317 318, Risk of serious cardiovascular events (e.g., MI, stroke).1 302 303 317 318 500 508, Risk of GI bleeding and ulceration.1 167 181 302 303 317 318, Risk of serious skin reactions.1 302 303 317 318 Risk of anaphylactoid and other sensitivity reactions.1 302 303 317 318, Importance of seeking immediate medical attention if signs and symptoms of a cardiovascular event (chest pain, dyspnea, weakness, slurred speech) occur.1 302 303 317 318 500 508, Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding, unexplained weight gain, or edema develops.1 302 303 317 318, Importance of discontinuing diclofenac and contacting clinician if rash or other signs of hypersensitivity (blisters, fever, pruritus) develop.1 302 303 317 318 Importance of seeking immediate medical attention if an anaphylactic reaction occurs.1 302 303 317 318, Importance of discontinuing therapy and contacting clinician immediately if signs and symptoms of hepatotoxicity (nausea, anorexia, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.1 302 303 317 318, Risk of heart failure or edema; importance of reporting dyspnea, unexplained weight gain, or edema.508, Importance of warning patients to keep diclofenac transdermal system out of the reach of children and pets and to safely dispose of used units.317 Importance of properly disposing of dosing cards used to apply diclofenac gel.318, Importance of adhering to instructions for administration of topical gel or transdermal system.317 318, Importance of avoiding or limiting exposure of skin treated with diclofenac gel to natural or artificial sunlight.318, Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 302 303 317 318 Importance of avoiding diclofenac in late pregnancy (third trimester).1 302 303 317 318, Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 302 303 317 318, Importance of informing patients of other important precautionary information.1 302 303 317 318 (See Cautions.). 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