Recommended Dosing Interval for Diclofenac
For osteoarthritis, the recommended dosage of diclofenac is 100-150 mg/day in divided doses, given as 50 mg twice a day or three times a day. 1
Dosing Recommendations by Formulation
Oral Diclofenac
- For osteoarthritis: 100-150 mg/day in divided doses (50 mg twice or three times daily) 1
- For rheumatoid arthritis: 150-200 mg/day in divided doses (50 mg three or four times daily) 1
- For pain or primary dysmenorrhea: 50 mg three times daily, with some patients benefiting from an initial 100 mg dose followed by 50 mg doses 1
Topical Diclofenac
- For hand osteoarthritis: Apply diclofenac gel twice daily for up to 8 weeks 2
- Topical application provides similar pain relief as oral NSAIDs with a more favorable safety profile 2
Dosing Considerations
Duration of Treatment
- Use the lowest effective dose for the shortest duration consistent with treatment goals to minimize adverse effects 1
- For over-the-counter use, maximum treatment duration should be 5 days for pain and 3 days for fever 3
- After observing initial response to therapy, adjust dose and frequency to suit individual patient needs 1
Formulation Differences
- Different formulations (sodium enteric-coated tablets, sodium extended-release tablets, potassium immediate-release tablets) are not necessarily bioequivalent even at the same milligram strength 1
- Diclofenac potassium (immediate-release) reaches peak plasma concentration in 30 minutes with a mean half-life of 1-2 hours, allowing for 4-6 hour duration of activity 3
- Fast-acting formulations (dispersible products, solutions, softgel) have similar efficacy at 50 mg doses 4
Safety Considerations
Risk Minimization
- Avoid prolonged use at high doses without periodic reassessment of benefits and risks 5
- Do not combine with other NSAIDs as this increases risk of adverse effects without providing additional benefit 5, 6
- For patients with increased gastrointestinal risk, consider using diclofenac with a gastroprotective agent 5
- Exercise caution in patients with cardiovascular risk factors, renal impairment, or history of gastrointestinal complications 5
Common Pitfalls to Avoid
- Exceeding the recommended maximum daily dose (200 mg for rheumatoid arthritis, 150 mg for osteoarthritis) 1
- Failing to adjust dosing based on individual patient response and tolerability 1
- Using different formulations interchangeably without accounting for differences in bioavailability 1
- Continuing high-dose therapy for extended periods without reassessing the risk-benefit ratio 5