What are the guidelines for administering diclofenac (Nonsteroidal Anti-Inflammatory Drug (NSAID)) via Intravenous (IV) injection?

Guidelines for Administering Diclofenac via Intravenous (IV) Injection

Intravenous diclofenac should be administered as a small volume bolus over 30-90 minutes, with doses typically ranging from 18.75-75 mg depending on the specific formulation and clinical indication. 1, 2

Dosing Recommendations

• Standard IV diclofenac doses range from 18.75 mg to 75 mg, with traditional formulations requiring dilution and administration over 30-120 minutes 1, 2
• Newer formulations solubilized with hydroxypropyl β-cyclodextrin (HPβCD) can be administered as a small volume bolus 1
• Lower doses (18.75 mg) have demonstrated efficacy for postoperative pain management while potentially reducing adverse effects 1, 2
• Doses can be repeated every 6 hours as needed for pain management 1

Administration Technique

• Ensure proper patient identification and appropriate vascular access before administration 3
• Have emergency medications and equipment readily available before administering IV diclofenac 3
• For traditional formulations, dilute appropriately and administer over 30-120 minutes 4, 5
• For newer HPβCD formulations, administer as a small volume bolus over 2-3 minutes while monitoring vital signs 3, 1
• Monitor for signs of hypersensitivity including rash, urticaria, hypotension, and bronchospasm during administration 3

Clinical Indications

• IV diclofenac is effective for acute moderate-to-severe postoperative pain management 1, 2
• It can significantly reduce opioid requirements when used as part of multimodal analgesia 1, 2
• IV diclofenac has demonstrated efficacy comparable to IV ketorolac in clinical trials 1
• It can be used for renal and biliary colic with efficacy comparable to or better than many narcotic and spasmolytic combinations 4

Precautions and Contraindications

• Avoid using diclofenac after gestational week 28 in pregnant patients due to risks of oligohydramnios or narrowing/occlusion of the fetal ductus arteriosus 6
• Use caution in patients with history of gastrointestinal ulceration or bleeding 7, 5
• Consider the relatively short elimination half-life (1.5 hours) when planning dosing intervals 4, 5
• Do not use IV diclofenac in combination with cryosurgery for actinic keratosis treatment, as evidence suggests no additional benefit 6

Monitoring and Safety

• Monitor vital signs before, during, and after administration 3
• Observe for adverse reactions specific to NSAIDs, particularly gastrointestinal effects 4, 7
• Be prepared to manage potential adverse reactions including gastrointestinal effects, which are generally less severe than with other NSAIDs like aspirin or indomethacin 4, 5
• The overall incidence of treatment-related adverse events with IV diclofenac is approximately 20% 1

Special Considerations

• Dosage adjustments are generally not required in elderly patients or those with renal or hepatic impairment 4
• Topical diclofenac may be considered as an alternative for localized pain, particularly for knee osteoarthritis 6
• For patients with chronic non-bacterial osteitis, diclofenac can be administered at 150 mg/day in divided doses initially, with maintenance doses of 75-100 mg/day 6

Common Pitfalls to Avoid

• Avoid rapid bolus administration of traditional diclofenac formulations that require dilution 3
• Do not administer through peripheral IV lines with questionable placement due to risk of extravasation 3
• Be aware that diclofenac, like other NSAIDs, may interfere with ovulation in women trying to conceive 6
• Avoid prolonged use of high doses due to potential gastrointestinal, cardiovascular, and renal adverse effects 7, 5