Diclofenac Sodium Suppository Dosing for a 9 kg Child
For a 9 kg child, the recommended dose of diclofenac sodium suppository is 1-1.5 mg/kg/day divided into 2-3 doses, which equals approximately 9-13.5 mg per day or 4.5-6.75 mg per dose when given twice daily.
Dosing Considerations
Weight-Based Dosing
- Based on the most recent pharmacokinetic evidence, diclofenac should be dosed at 1-1.5 mg/kg/day for children 1
- For a 9 kg child, this translates to:
- Total daily dose: 9-13.5 mg per day
- If divided into 2 doses: 4.5-6.75 mg per dose
- If divided into 3 doses: 3-4.5 mg per dose
Available Formulations
- Diclofenac sodium suppositories typically come in strengths of 12.5 mg, 25 mg, 50 mg, and 100 mg
- For a 9 kg child, the 12.5 mg suppository would be the closest available strength, but would still exceed the recommended dose
- Consider consulting with a pharmacist about the possibility of cutting a 12.5 mg suppository or using a compounded lower-strength formulation
Clinical Considerations
Safety Profile
- Diclofenac has a relatively short elimination half-life (1.5 hours in plasma), which limits potential for drug accumulation 2
- However, the drug persists longer in synovial fluid, providing extended anti-inflammatory effects despite its short plasma half-life 2
Special Populations
- No dosage adjustments are typically required based on age alone 3
- Renal function should be considered as diclofenac conjugates are excreted renally 4
Administration Timing
- Administer at regular intervals to maintain therapeutic effect
- For twice daily dosing, space doses approximately 12 hours apart
Monitoring and Precautions
Side Effects to Monitor
- Gastrointestinal effects (most common adverse effects)
- Renal function
- Signs of allergic reaction
Drug Interactions
- Be aware of potential interactions with:
- Aspirin (increased risk of adverse effects)
- Lithium (increased lithium levels)
- Methotrexate (increased toxicity)
- Digoxin (increased serum levels)
- Cyclosporine (increased nephrotoxicity) 4
Important Caveats
- Always use the lowest effective dose for the shortest duration possible to minimize adverse effects
- Diclofenac suppositories should not be used in children with known hypersensitivity to NSAIDs
- Monitor for signs of GI bleeding or renal impairment during treatment
- If the child is unable to tolerate the suppository form, consider alternative NSAIDs in age-appropriate formulations
Remember that while diclofenac is effective for pain management, its use should be carefully considered in pediatric patients, particularly in very young children, and the benefits should outweigh the potential risks.