What is the maximum recommended dose of Cataflam (diclofenac)?

Maximum Recommended Dose of Cataflam (Diclofenac)

The maximum recommended daily dose of Cataflam (diclofenac potassium) is 150 mg per day for most conditions, with a maximum of 200 mg per day for rheumatoid arthritis. 1

Dosing Guidelines by Formulation

Diclofenac Potassium (Cataflam)

• Standard dosing: 50 mg three times daily (150 mg/day) 2
• Rheumatoid arthritis: Can be increased to 150-200 mg daily in divided doses 2
• Over-the-counter formulation: Maximum 75 mg/day (initial dose of two 12.5 mg tablets followed by one or two tablets every 4-6 hours) 3

Diclofenac Sodium

• Standard dosing: 50 mg three times daily or 75 mg twice daily (150 mg/day)
• Slow-release formulation: Can be administered once or twice daily

Dosing by Condition

1. Rheumatoid arthritis:

   • 150-200 mg daily in divided doses 2
   • Typically 50 mg three times daily

2. Osteoarthritis:

   • 100-150 mg daily in divided doses 2
   • Typically 50 mg two or three times daily

3. Ankylosing spondylitis:

   • 100-150 mg daily in divided doses 2

4. Acute pain conditions:

   • 50 mg three times daily (150 mg/day) 4
   • For short-term use (≤5 days for pain, ≤3 days for fever) 3

Important Considerations

Risk Factors Requiring Dose Adjustment

• Elderly patients: Start at the lower end of the dosing range 1
• Renal impairment: Use caution as diclofenac is substantially excreted by the kidneys 1
• Hepatic impairment: Monitor closely due to risk of hepatotoxicity 1

Formulation Differences

• Diclofenac potassium (Cataflam): Immediate-release, faster onset (peak plasma concentration in 30 minutes) 3
• Diclofenac sodium: Often enteric-coated, slower onset but similar overall bioavailability

Adverse Effects at Maximum Doses

• Increased risk of gastrointestinal bleeding and ulceration
• Increased cardiovascular risks (thrombotic events)
• Renal toxicity, especially with prolonged use
• Hepatotoxicity

Administration Recommendations

• Take with food to minimize gastrointestinal side effects
• For acute pain, diclofenac potassium is preferred over diclofenac sodium due to faster onset 4
• Consider topical diclofenac formulations for localized pain to minimize systemic exposure 5

Common Pitfalls

1. Exceeding maximum doses: No additional analgesic benefit beyond maximum doses, but significantly increased risk of adverse effects
2. Prolonged use at maximum doses: Increases risk of serious cardiovascular and gastrointestinal events
3. Combining with other NSAIDs: Avoid concurrent use with other NSAIDs as this increases toxicity without improving efficacy
4. Inadequate monitoring: Patients on long-term or maximum doses should have regular monitoring of renal and hepatic function

Remember that while diclofenac is effective for pain management, it should be used at the lowest effective dose for the shortest duration possible to minimize risks of adverse effects.