Jonac (Diclofenac) Suppository Dosing for Adults
For adults, diclofenac suppositories are typically dosed at 100 mg once daily (usually at bedtime) or 50 mg twice daily, with a maximum daily dose not exceeding 150 mg total from all routes of administration combined. 1, 2
Standard Dosing Regimens
Suppository-specific dosing:
- 100 mg once daily (typically administered at night) is the most common suppository regimen 2
- Alternatively, 50 mg twice daily can be used if divided dosing is preferred 2
- The maximum total daily dose is 150 mg regardless of formulation or route (oral, rectal, or intramuscular combined) 1, 2, 3
Clinical Context for Dosing
For rheumatic conditions (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis):
- Total daily doses of 100-150 mg are standard and comparable in efficacy to other NSAIDs 2, 3, 4
- Suppositories can be used as part of the total daily dose or as monotherapy 2
For acute pain conditions (postoperative pain, renal colic, trauma):
- 75-100 mg as a single suppository dose provides effective analgesia 4, 5
- Can be repeated with minimum 12-hour intervals between doses 1
Critical Safety Considerations
Maximum dose limits are strict:
- Never exceed 150 mg total daily from all diclofenac formulations combined (if using suppositories plus oral or injectable forms) 1, 2
- Higher doses significantly increase gastrointestinal and renal toxicity risk 1
High-risk populations requiring caution or dose reduction:
- Patients >60 years old 1
- History of peptic ulcer disease 1
- Renal impairment (consider dose reduction if creatinine clearance <10 mL/min) 1
- Hepatic dysfunction 1
- Concurrent anticoagulant use (significantly increases bleeding risk) 1
- Pre-existing cardiovascular disease 1
Monitoring Requirements for Chronic Use
If suppositories are used beyond acute treatment (>2 weeks):
- Monitor blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood at baseline and every 3 months 1
- Discontinue if BUN or creatinine doubles 1
- Discontinue if liver enzymes increase to 3× upper limit of normal 1
Common Pitfalls to Avoid
- Do not combine multiple diclofenac formulations without accounting for total daily dose (e.g., suppository + oral tablets must not exceed 150 mg combined) 1, 2
- Avoid in active peptic ulcer disease - this is an absolute contraindication 1
- Do not use "as needed" dosing for chronic conditions - fixed-interval dosing is more effective for inflammatory conditions 2, 3
- Suppositories have the same systemic absorption and toxicity profile as oral forms, so the same precautions apply 2, 6