From the Guidelines
Diclofenac dosing for osteoarthritis and rheumatoid arthritis should be initiated at the lowest effective dose, typically ranging from 100-150 mg daily, divided into multiple doses, with a strong recommendation to use the minimum effective dose for the shortest time possible to minimize adverse effects, as suggested by the most recent guidelines 1.
Key Considerations
- For osteoarthritis, the standard oral dosage is 50 mg two to three times daily or 75 mg twice daily.
- For rheumatoid arthritis, patients usually take 50 mg three times daily or 75 mg twice daily.
- Extended-release formulations are available as 100 mg once daily.
- Topical diclofenac preparations (gels or patches) can be applied to affected joints 3-4 times daily for localized relief with fewer systemic side effects.
Monitoring and Precautions
- Patients should take diclofenac with food to reduce gastrointestinal irritation.
- Monitoring for potential side effects including gastrointestinal bleeding, cardiovascular events, and renal impairment is crucial, particularly in elderly patients or those with pre-existing conditions.
- The use of oral NSAIDs, including diclofenac, should be carefully considered in patients with a history of gastrointestinal issues, cardiovascular disease, or renal impairment, and the lowest effective dose should be used for the shortest duration possible, as recommended by recent clinical practice guidelines 1.
Evidence Summary
- Recent guidelines strongly recommend the use of oral NSAIDs, including diclofenac, for people with knee, hip, hand, and/or polyarticular OA unless contraindicated, with an emphasis on using the lowest effective dose for the shortest time possible 1.
- Topical NSAIDs, such as diclofenac, are also recommended for knee, hip, and/or hand OA, particularly for older adults (>75 years) with only a few symptomatic joints, due to their safety and efficacy profile 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION ... For the relief of osteoarthritis the recommended dosage is 100 to 150 mg/day in divided doses, 50 mg b.i.d. or t.i.d. For the relief of rheumatoid arthritis the recommended dosage is 150 to 200 mg/day in divided doses, 50 mg t.i.d. or q.i.d. The recommended dosing for diclofenac in the treatment of:
- Osteoarthritis: 100 to 150 mg/day in divided doses, 50 mg b.i.d. or t.i.d.
- Rheumatoid arthritis: 150 to 200 mg/day in divided doses, 50 mg t.i.d. or q.i.d. 2
From the Research
Diclofenac Dosing
- 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, with a typical dosing regimen of 25 to 50mg three times daily 4.
- Some studies suggest that diclofenac can be effective when administered twice daily, or once daily as a slow release tablet 4, 5.
- A low-dose SoluMatrix diclofenac formulation has been developed, which provides efficacy at lower diclofenac doses, with a recommended dosing regimen of 35 mg twice daily 6.
- A prolonged-release formulation of diclofenac sodium, allowing for single administration of the daily dose of 150 mg, has also been shown to be effective in treating osteoarthritis 7.
Conditions Treated
- Diclofenac is used to treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis 3, 4, 5.
- It has also been used to treat pain resulting from minor surgery, trauma, and dysmenorrhoea 4.
Efficacy and Safety
- Diclofenac has been shown to be effective in reducing pain and improving function in patients with osteoarthritis and rheumatoid arthritis 3, 4, 6.
- It has a similar efficacy profile to other NSAIDs, such as aspirin, indomethacin, and naproxen 3, 4.
- Diclofenac has been associated with gastrointestinal adverse effects, but these are generally fewer and less serious than those associated with aspirin or indomethacin 3, 4.