Diclofenac Suppository Dosing for Pediatric Patients
The recommended dose of diclofenac suppository for pediatric patients is 0.5-1 mg/kg every 8 hours. 1
Age-Specific Dosing Recommendations
- For children of all ages requiring rectal administration of diclofenac, the recommended dose is 0.5-1 mg/kg every 8 hours 1
- This dosing has been established as effective for pain management in the postoperative setting 2
- Single doses of 0.5 mg/kg for suppositories are recommended for children aged 1-12 years to yield a similar area under the concentration-time curve (AUC) to a 50 mg dose in adults 3
Clinical Considerations
Efficacy
- Diclofenac suppositories have demonstrated superior antipyretic effectiveness compared to paracetamol suppositories in the first hour of administration 4
- As an NSAID, diclofenac is effective for perioperative acute pain management in children 5
- Diclofenac probably results in less nausea and vomiting compared to opioids for postoperative pain management (moderate-certainty evidence) 2
Administration Considerations
- Do not administer more than 150 mg per dose site 1
- Diclofenac can be used as adjuvant therapy for pain and inflammation in children 1
- Although diclofenac is not FDA or EMA approved for pediatric use in some regions, it can be considered at the discretion of the treating physician based on clinical experience 1
Pharmacokinetics
- The bioavailability of diclofenac suppositories in children is approximately 0.63 3
- Diclofenac is eliminated following biotransformation to glucoroconjugated and sulphate metabolites which are excreted in urine 6
- Very little of the drug is eliminated unchanged 6
Safety Considerations
- Monitor for potential bleeding complications, as diclofenac probably increases the risk of bleeding compared to opioids (moderate-certainty evidence) 2
- Serious diclofenac adverse reactions occur in fewer than 0.24% of children treated for acute pain 5
- The types of serious adverse reactions in children are similar to those reported in adults 5
- No dosage adjustments are typically required for children with various disease states (such as hepatic disease) 6
Common Pitfalls and Caveats
- Avoid using diclofenac in children with known hypersensitivity to NSAIDs 5
- Be cautious when using in children with asthma, as more research on safety in asthmatic children is required 5
- Consider the risk of bleeding when using diclofenac in the perioperative period, especially for surgeries where bleeding is a concern 2
- NSAID adjuvant therapy requires an adequate trial period of at least 8 weeks for chronic conditions, given the time course to response of about 1 month 1