Diclofenac Dosing Recommendations
For optimal pain management, diclofenac should be dosed at 50 mg three times daily for most conditions, with adjustments based on specific indications. 1
FDA-Approved Dosing Guidelines
- Pain or Primary Dysmenorrhea: 50 mg three times daily; in some patients, an initial dose of 100 mg followed by 50 mg doses may provide better relief 1
- Osteoarthritis: 100-150 mg/day in divided doses (50 mg twice or three times daily) 1
- Rheumatoid Arthritis: 150-200 mg/day in divided doses (50 mg three or four times daily) 1
- Always use the lowest effective dose for the shortest duration to minimize adverse effects 1
Condition-Specific Dosing
Chronic Non-Bacterial Osteitis (CNO)
- Start with maximum tolerated and approved dosage for 2-4 weeks 2
- Recommended dosage: 150 mg/day in divided doses (starting dose), maintenance 75-100 mg/day in divided doses 2
- Evaluate treatment response after 2-4 weeks; consider tapering with sustained response at 12 weeks 2
Acute Ankle Sprains
- Short-term use (<14 days) is effective for pain reduction 2
- Diclofenac shows superior results at days 1 and 2 compared with piroxicam and ibuprofen for reducing pain during motion 2
Degenerative Arthritis
- Consider diclofenac as a second or third-line option after paracetamol and ibuprofen trials 2
- Diclofenac is comparable in efficacy to other NSAIDs for osteoarthritis 3
Formulation Considerations
- Different formulations are not bioequivalent even at the same milligram strength 1
- Available forms include:
Special Populations
- Elderly patients: No specific dosage adjustments required, but use caution due to increased risk of adverse effects 5
- Renal impairment: No accumulation in elderly individuals, but conjugate accumulation may occur in end-stage renal disease 5
- Hepatic disease: No specific dosage adjustments required 5
Safety Considerations
- Gastrointestinal complications are the most frequent adverse effects 3
- Consider gastroprotective agents (H2 blockers, misoprostol, proton pump inhibitors) in high-risk patients 2, 6
- For over-the-counter use, low-dose diclofenac potassium (12.5mg) can be used with a maximum daily dose of 75 mg for no more than 5 days for pain and 3 days for fever 7
Pitfalls to Avoid
- Avoid prolonged use due to increased risk of gastrointestinal, cardiovascular, and renal adverse effects 1
- Be aware of potential drug interactions with aspirin, lithium, digoxin, methotrexate, cyclosporin, cholestyramine, and colestipol 5
- NSAIDs may delay natural healing processes as the inflammation suppressed is a necessary component of tissue recovery 2
Remember to always use the lowest effective dose for the shortest duration consistent with individual treatment goals to minimize adverse effects while achieving therapeutic benefits.