What are the dosage and treatment guidelines for Diclofenac (Non-Steroidal Anti-Inflammatory Drug (NSAID))?

From the Guidelines

Diclofenac should be used topically as a first-line pharmacological treatment for hand osteoarthritis, due to its favorable safety profile and beneficial effects on pain and function, as shown in a high-quality study from 2019 1. When considering the use of Diclofenac, it's essential to weigh the benefits and risks, particularly in patients with a high risk of adverse effects, such as those aged 65 years or older, or with comorbid hypertension, type 2 diabetes, or cerebrovascular or cardiovascular disease.

• Topical diclofenac gel has been shown to have a similar safety profile to placebo, even in high-risk patients, making it a preferred option over systemic treatments 1.
• The recommended dosage for topical diclofenac is not explicitly stated in the provided evidence, but it is typically used as a 1-2% gel or patch applied to affected areas 3-4 times daily.
• Systemic pharmacological treatment may be preferred when a large number of joints are affected, but the evidence for long-term effects of topical NSAIDs is limited 1.
• It's crucial to monitor patients regularly during extended use of diclofenac, as side effects can include stomach upset, ulcers, increased blood pressure, and fluid retention.
• Diclofenac works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin production and thereby decreasing inflammation, pain, and fever.
• Patients should be advised to take diclofenac with food to reduce gastrointestinal irritation and avoid alcohol and other NSAIDs during treatment.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of diclofenac potassium tablets and other treatment options before deciding to use diclofenac potassium tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS: Gastrointestinal Bleeding, Ulceration, and Perforation) After observing the response to initial therapy with diclofenac potassium tablets, the dose and frequency should be adjusted to suit an individual patient's needs. For treatment of pain or primary dysmenorrhea the recommended dosage is 50 mg three times a day With experience, physicians may find that in some patients an initial dose of 100 mg of diclofenac potassium tablets, followed by 50 mg doses, will provide better relief. For the relief of osteoarthritis, the recommended dosage is 100-150 mg/day in divided doses, 50 mg twice a day or three times a day For the relief of rheumatoid arthritis, the recommended dosage is 150-200 mg/day in divided doses, 50 mg three times a day or four times a day. The dosage guidelines for Diclofenac are as follows:

• For pain or primary dysmenorrhea: 50 mg three times a day
• For osteoarthritis: 100-150 mg/day in divided doses, 50 mg twice a day or three times a day
• For rheumatoid arthritis: 150-200 mg/day in divided doses, 50 mg three times a day or four times a day The treatment guidelines recommend using the lowest effective dose for the shortest duration consistent with individual patient treatment goals 2.

From the Research

Diclofenac Dosage and Treatment Guidelines

• The recommended total daily dosage of Diclofenac is 100 to 150 mg for osteoarthritis and ankylosing spondylitis, and 150 to 200 mg for rheumatoid arthritis 3.
• Diclofenac can be administered in divided doses with meals 3.
• For acute postoperative pain, single dose oral Diclofenac has been shown to be effective, with doses ranging from 25 mg to 100 mg 4, 5.
• The number needed to treat (NNT) for at least 50% relief over four to six hours with Diclofenac 25 mg, 50 mg, and 100 mg compared with placebo was 2.8,2.3, and 1.9, respectively 5.
• Diclofenac potassium and sodium salts have been compared, with Diclofenac potassium showing significantly lower NNTs for pain relief 4.

Efficacy and Safety

• Diclofenac has been shown to be effective in improving function and reducing pain in patients with rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis 3.
• The most frequent adverse effects reported for Diclofenac were gastrointestinal, but these effects were fewer and less serious than occurred with aspirin or indomethacin 3.
• Diclofenac has been shown to have a good systemic tolerability, with superimposable results in different administration schemes 6.
• Gastrointestinal tolerance was better in patients receiving Diclofenac prolonged-release capsules compared to those receiving enteric-coated tablets 6.

Administration and Formulations

• Diclofenac is available as a potassium salt (immediate-release) or sodium salt (delayed-release) 4, 5.
• Diclofenac can be administered orally or by intramuscular injection, with doses ranging from 50 to 75 mg daily, or up to 150 mg per day for longer-term use 7.
• Prolonged-release capsules and enteric-coated tablets are available, with the prolonged-release capsules often inducing a quicker response 6.