What is the usage and dosage of the Olfen (diclofenac) patch for treating actinic keratosis or musculoskeletal pain?

Olfen (Diclofenac) Patch Usage and Dosage

For Actinic Keratosis

Diclofenac is NOT available as a patch formulation for actinic keratosis treatment, and the American Academy of Dermatology conditionally recommends AGAINST using diclofenac in addition to cryosurgery compared to cryosurgery alone. 1

Available Diclofenac Formulation for Actinic Keratosis

• Diclofenac 3% in 2.5% hyaluronic acid gel is the only approved topical formulation for actinic keratosis treatment 2
• Applied twice daily for 60-90 days to the affected area 2
• Can be used as either lesion-directed or field-directed treatment 2

Efficacy Profile

• Achieves 50% complete clearance after 90 days of treatment, compared to 20% with vehicle alone 2
• Extending treatment from 90 to 180 days provides only an additional 5% complete clearance 2
• Less effective than 5-fluorouracil or imiquimod but causes significantly less intense local skin reactions 2
• The British Association of Dermatologists rates diclofenac as having lower efficacy compared to first-line topical agents 1

Clinical Positioning

• The American Academy of Dermatology gives diclofenac only a conditional recommendation with lower quality evidence than 5-FU or imiquimod 1
• Best suited for patients who cannot tolerate the more intense inflammatory reactions of 5-FU or imiquimod 2, 3
• Not recommended as combination therapy with cryosurgery based on guideline evidence 1

---

For Musculoskeletal Pain

The diclofenac epolamine patch (Flector) is specifically formulated for localized musculoskeletal pain, NOT the diclofenac sodium topical solution.

Diclofenac Sodium Topical Solution Dosing (FDA-Approved)

• 40 mg (2 pump actuations) applied to each painful knee, twice daily 4
• Approved specifically for osteoarthritis of the knee(s) 4
• Apply to clean, dry skin and spread evenly around front, back, and sides of the knee 4

Application Instructions

• Prime the pump before first use by fully depressing 4 times (discard this portion) 4
• Dispense directly onto knee or into hand first, then apply 4
• Wash hands completely after application 4
• Avoid showering/bathing for at least 30 minutes after application 4
• Wait until area is completely dry before covering with clothing or applying other topical products 4
• Avoid skin-to-skin contact with others until treated area is completely dry 4

Diclofenac Epolamine Patch (Flector) Evidence

• Provides pain relief beginning at 3 hours after application for conditions like ankle sprains and knee osteoarthritis 5
• Diclofenac first appears in plasma at a mean of 4.5 hours (range 2-8 hours), demonstrating local tissue accumulation provides the therapeutic effect before systemic absorption 5
• Bioavailability is only 1% compared to oral intake, with steady-state plasma concentrations of 1-3 ng/mL 5
• Applied for 12 hours per application in clinical studies 5

Important Safety Considerations

• Do not use combination therapy with topical diclofenac and oral NSAIDs unless benefit outweighs risk, with periodic laboratory monitoring 4
• Diclofenac may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke 2
• Patients with cardiovascular disease or risk factors require heightened caution 2
• Topical formulations have a more favorable safety profile than oral NSAIDs, particularly beneficial for older patients 2

Critical Pitfalls to Avoid

• Do not apply to open wounds or mucous membranes 4
• Do not apply external heat or occlusive dressings to treated areas 4
• Protect treated areas from natural and artificial sunlight 4
• Use the lowest effective dosage for the shortest duration consistent with treatment goals 4