What is the recommended preparation for Diclofenac (Diclofenac sodium) intravenous (IV) infusion?

Recommended Preparation for Diclofenac IV Infusion

Diclofenac sodium for IV infusion should be prepared using hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer, allowing for administration as a small volume bolus injection rather than requiring a lengthy infusion.

Preparation Guidelines

Formulation Selection

• Use HPβCD diclofenac formulation (such as Dyloject®) which allows for:
  • Small volume administration (1 mL for 75 mg dose)
  • Rapid bolus injection rather than slow infusion
  • Reduced risk of thrombophlebitis compared to older formulations 1

Dosing Options

• Standard dose: 75 mg in 1 mL solution 2
• Lower doses (18.75 mg or 37.5 mg) may be effective for moderate pain with potentially fewer side effects 3

Administration Method

• Administer as IV bolus injection over 5-15 seconds 2
• No need for dilution or preparation of infusion solutions
• Can be given directly without the 30-minute infusion time required by older formulations 1

Clinical Considerations

Advantages of HPβCD Diclofenac Formulation

• Bioequivalent to older propylene glycol/benzyl alcohol (PG-BA) formulations but with:
  • Faster onset of action (significant pain relief at 15 minutes) 4
  • Lower incidence of thrombophlebitis 4, 1
  • No need for preparation for each patient 4

Safety Profile

• Generally well-tolerated with adverse events similar to placebo in clinical trials 5
• Most common adverse reactions:
  • Infusion-site pain
  • Dizziness
  • Constipation 5

Monitoring Requirements

• Monitor blood pressure and ECG during administration, particularly with rapid infusion 6
• Observe for signs of infusion site reactions
• Monitor for potential NSAID-related adverse effects (gastrointestinal, renal, cardiovascular)

Contraindications and Precautions

• Use with caution in patients with:
  • Liver disease (may increase liver enzymes) 7
  • Cardiovascular disease
  • Renal impairment
• Avoid in patients with:
  • History of GI bleeding
  • Hypersensitivity to NSAIDs
  • Third trimester of pregnancy

Key Pitfalls to Avoid

1. Do not confuse with older diclofenac formulations that require 30-120 minute infusions
2. Do not administer too rapidly in patients with cardiovascular instability
3. Avoid using in patients with recent gastrointestinal bleeding or high risk of bleeding
4. Consider potential drug interactions with other medications that may increase bleeding risk

The HPβCD diclofenac formulation represents a significant improvement over traditional diclofenac IV preparations, offering faster onset, equivalent efficacy, and improved safety profile when administered as directed.