From the FDA Drug Label
DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of diclofenac potassium tablets and other treatment options before deciding to use diclofenac potassium tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS: Gastrointestinal Bleeding, Ulceration, and Perforation) After observing the response to initial therapy with diclofenac potassium tablets, the dose and frequency should be adjusted to suit an individual patient's needs. For treatment of pain or primary dysmenorrhea the recommended dosage is 50 mg three times a day With experience, physicians may find that in some patients an initial dose of 100 mg of diclofenac potassium tablets, followed by 50 mg doses, will provide better relief. For the relief of osteoarthritis, the recommended dosage is 100-150 mg/day in divided doses, 50 mg twice a day or three times a day For the relief of rheumatoid arthritis, the recommended dosage is 150-200 mg/day in divided doses, 50 mg three times a day or four times a day. The recommended dosage of diclofenac is:
- For pain or primary dysmenorrhea: 50 mg three times a day
- For osteoarthritis: 100-150 mg/day in divided doses, 50 mg twice a day or three times a day
- For rheumatoid arthritis: 150-200 mg/day in divided doses, 50 mg three times a day or four times a day 1
From the Research
Diclofenac should be dosed at 50 mg taken orally 2-3 times daily for a total daily dose of 100-150 mg for most adults with pain or inflammation, with consideration of the lowest effective dose for the shortest possible time to minimize cardiovascular and gastrointestinal risks, as supported by the most recent evidence 2.
Key Considerations
- For osteoarthritis, the recommended dose is 50 mg 2-3 times daily or 75 mg twice daily.
- For rheumatoid arthritis, dosing may be increased to a maximum of 200 mg daily in divided doses.
- Extended-release formulations are available as 100 mg once daily.
- Topical diclofenac gel (1%) can be applied as 2-4 g to the affected area 4 times daily.
- Lower doses should be used in elderly patients and those with renal impairment.
- Treatment duration should be limited to the shortest period necessary to control symptoms, typically 7-14 days for acute conditions.
Gastroprotective Agents
- Considering gastroprotective agents like proton pump inhibitors for patients at high risk of GI complications is advisable, although the most recent study suggests a higher risk of lower gastrointestinal bleeding in NSAID+PPI users compared to NSAID-only users 2.
- However, the risk of lower gastrointestinal bleeding was comparable between NSAID+mucoprotective agent users and NSAID-only users.
Monitoring and Precautions
- Patients should avoid using multiple NSAIDs simultaneously and should be monitored for potential side effects including gastrointestinal bleeding, cardiovascular events, and renal dysfunction.
- Diclofenac works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin synthesis and thereby decreasing pain and inflammation.
- Taking diclofenac with food may help reduce gastrointestinal side effects.
Evidence-Based Recommendations
- The most recent study 2 provides evidence for the risk of lower gastrointestinal bleeding in NSAID+PPI users, which should be considered when prescribing diclofenac.
- Previous studies 3, 4, 5, 6 provide additional information on the risks and benefits of diclofenac and gastroprotective agents, but the most recent evidence should take precedence in guiding clinical decision-making.