What is the recommended dosage and usage of Rofenac (diclofenac) suppository for treating severe dysmenorrhea or post-operative pain?

Recommended Dosage and Usage of Diclofenac Suppository for Severe Dysmenorrhea or Post-operative Pain

For severe dysmenorrhea or post-operative pain, diclofenac suppositories should be administered at a dosage of 50-100 mg every 8 hours, with a maximum daily dose of 150 mg. 1

Dosage Recommendations

For Adults:

• Diclofenac suppository 50-100 mg every 8 hours for post-operative pain, not exceeding 150 mg daily 1
• For severe dysmenorrhea, 50-75 mg initially, followed by 50 mg every 8 hours as needed 2
• Duration of treatment should be limited to the acute pain period (typically 2-3 days for dysmenorrhea, 3-5 days for post-operative pain) 1

For Children:

• Diclofenac suppository 0.5-1 mg/kg every 8 hours for post-operative pain 1
• Not recommended for children under 12 years without specific pediatric evaluation 1

Clinical Considerations

For Post-operative Pain:

• Diclofenac suppositories are particularly useful when oral administration is not feasible in the immediate post-operative period 1
• Should be incorporated into a multimodal analgesic approach:
  • Combine with paracetamol (acetaminophen) for enhanced analgesia 1
  • For severe post-operative pain unresponsive to NSAIDs alone, add a strong opioid (morphine or oxycodone) 1
• Intravenous lidocaine (1-2 mg/kg bolus followed by 1-2 mg/kg/h infusion) may be considered as an alternative for major abdominal, pelvic, or spinal surgeries when regional analgesia is not used 1

For Dysmenorrhea:

• Diclofenac has shown similar efficacy to other NSAIDs such as piroxicam and naproxen in treating primary dysmenorrhea 2
• Should be initiated at the onset of menstrual pain or prophylactically at the start of menstruation 2, 3

Important Contraindications and Precautions

• Do not combine with curative doses of anticoagulants due to 2.5-fold increased risk of severe bleeding 1, 4
• Avoid in patients with:
  • History of atherothrombosis (peripheral artery disease, stroke, myocardial infarction) 1
  • Renal impairment (estimated creatinine clearance <50 mL/min) 1
  • History of gastrointestinal bleeding or ulceration 4
• Consider adding dexamethasone (8 mg IV in adults, 0.15 mg/kg in children) to reduce post-operative pain and nausea/vomiting 1

Comparative Efficacy

• Diclofenac 50 mg provides similar pain relief to ibuprofen 400 mg in post-operative pain settings 5
• The number-needed-to-treat (NNT) for at least 50% pain relief with diclofenac 50 mg is 2.3 and for diclofenac 100 mg is 1.8, indicating high efficacy 6, 5
• For dysmenorrhea, diclofenac 75 mg shows comparable efficacy to piroxicam 20 mg 2

Common Pitfalls and Caveats

• Rectal administration may have variable absorption compared to oral formulations; monitor response and adjust accordingly 6
• Prolonged use beyond 7 days in patients with cardiovascular risk factors should be avoided 1, 4
• For severe post-operative pain, consider small doses of ketamine (0.5 mg/kg followed by 0.125-0.25 mg/kg/h) as an adjunct for patients with high risk of chronic post-operative pain or those on long-term opioids 1
• Monitor for gastrointestinal and renal adverse effects, particularly in elderly patients or those with pre-existing conditions 4