Diclofenac Dosing for a 3-Year-Old Child (22kg)
For a 3-year-old child weighing 22kg, the recommended dose of diclofenac is 1 mg/kg per dose (22mg), administered rectally every 8 hours, with a maximum daily dose of 3 mg/kg/day (66mg total). This translates to approximately two 12.5mg suppositories per dose.
Weight-Based Dosing Calculation
- The most commonly used intraoperative dose of diclofenac in pediatric practice is 1 mg/kg, administered every 8 hours 1
- A pharmacokinetic meta-analysis specifically recommends 0.5 mg/kg for rectal suppositories to achieve equivalent drug exposure to adult dosing 2
- For your 22kg child: 22kg × 1 mg/kg = 22mg per dose (approximately two 12.5mg suppositories)
- Maximum daily dose should not exceed 3 mg/kg/day = 66mg total daily 2
Route of Administration Considerations
- Rectal administration (suppositories) is the most common route used in pediatric anesthesia practice (80% of practitioners) 1
- Rectal diclofenac has a bioavailability of 0.63, which is higher than oral suspension (0.36) but requires appropriate dose adjustment 2
- The 12.5mg suppository formulation (Rofenac) is specifically designed for pediatric use 1
Dosing Interval and Duration
- The standard dosing interval is every 8 hours (three times daily) as practiced by 53% of pediatric anesthetists 1
- Diclofenac should be used as part of multimodal analgesia, not as monotherapy, particularly for postoperative pain management 1
Critical Safety Considerations
Important caveats:
- Diclofenac is currently licensed only for children over 1 year of age, making this an appropriate age for use 1
- Most pediatric use remains off-label despite widespread clinical practice, as pharmacokinetic and pharmacodynamic data in young children are limited 1, 3
- Avoid use in children with bleeding disorders, active peptic ulcer disease, or significant renal impairment 4
- Do not use in adenotonsillectomy patients due to bleeding risk concerns 1
- Monitor for gastrointestinal side effects and ensure adequate hydration 4
Practical Administration
- For the 12.5mg suppository: administer 2 suppositories (25mg total) per dose if using the 1 mg/kg dosing strategy
- Alternatively, use 1 suppository (12.5mg) per dose if following the more conservative 0.5 mg/kg rectal dosing recommendation from pharmacokinetic studies 2
- The conservative approach of 12.5mg (one suppository) every 8 hours is recommended as the starting dose, which can be increased to 25mg (two suppositories) if analgesia is inadequate and the child tolerates the medication well 2