Diclofenac Suppositories for Children and Adults
Diclofenac suppositories are an effective NSAID formulation for pain management in both children and adults, with rectal diclofenac showing superior antipyretic effects compared to paracetamol in children, though dosing must be carefully adjusted by age and weight.
Dosing Recommendations
For Children:
- Children 1-12 years: 0.5 mg/kg per dose for rectal administration 1
- Maximum daily dose: Should not exceed 1.5 mg/kg/day divided into 2-3 doses
- Duration: Limited to short-term use (less than 3 days for fever, up to 7 days for pain)
- Minimum age: Not recommended for infants under 1 year due to limited safety data
For Adults:
- Standard dose: 50-100 mg per suppository
- Frequency: 1-2 times daily
- Maximum daily dose: 150 mg
Clinical Applications
Pain Management:
- Acute pain: Effective for post-surgical pain, renal colic, and migraine headaches 2
- Chronic pain: Can be used for arthritis pain but oral/topical routes preferred for long-term use
- Migraine: Considered a first-line NSAID option for acute migraine attacks 2
Fever Management:
- More effective than paracetamol suppositories for fever reduction in children
- Produces greater temperature reduction (1.73°C vs 0.65°C) within the first hour compared to paracetamol 3
Advantages of Rectal Administration
- Bypasses first-pass metabolism
- Useful when oral administration is difficult (vomiting, NPO status)
- Higher bioavailability (63%) compared to oral suspension (36%) 1
- Longer duration of action compared to some oral formulations
- Avoids gastric irritation associated with oral NSAIDs
Contraindications and Precautions
- Pregnancy: Contraindicated especially after 20 weeks gestation 4
- Breastfeeding: Use with caution and only after consulting healthcare provider
- Gastrointestinal conditions: History of GI bleeding or ulceration
- Renal impairment: Use with caution in patients with kidney disease
- Allergies: Previous hypersensitivity to NSAIDs
- Asthma: Use with caution in patients with NSAID-induced asthma
Special Considerations for Children
Rectal diclofenac is particularly useful for children who:
- Cannot tolerate oral medications
- Are experiencing vomiting
- Need rapid fever reduction
- Require post-surgical pain management
For juvenile idiopathic arthritis with active sacroiliitis, NSAIDs including diclofenac are strongly recommended as first-line therapy 2
Common Pitfalls and Caveats
- Overuse: Limit duration to avoid systemic adverse effects
- Incorrect dosing: Weight-based dosing is critical in children to avoid toxicity
- Inappropriate use in pregnancy: Avoid in late pregnancy due to risks to the fetus 4
- Medication overuse headache: Can occur with frequent use for migraines 2
- Concomitant NSAID use: Avoid using with other NSAIDs to prevent additive toxicity
Monitoring
- Monitor for signs of GI bleeding (black stools, abdominal pain)
- Watch for changes in renal function with prolonged use
- Assess for allergic reactions, particularly in patients with previous NSAID sensitivity
- In children, monitor for adequate hydration, especially during febrile illness
Diclofenac suppositories represent an effective alternative to oral NSAIDs when that route is unavailable or contraindicated, with particular utility in pediatric patients with fever or pain who cannot tolerate oral medications.