Diclofenac

Overview

Highly potent NSAID with slightly more selectivity for COX-2 than COX-1. Excellent pain relief, but possesses the highest cardiovascular toxicity of all traditional NSAIDs.

Maximum Dose

Max 150 mg/day (e.g., 50 mg TDS).

Clinical Focus

Strictly contraindicated in patients with a history of myocardial infarction, stroke, or severe heart failure due to a massive risk of thrombotic events.

Bottom Line

Diclofenac is a potent NSAID available in multiple formulations for acute pain and inflammation, but has the highest cardiovascular risk of common NSAIDs and should be avoided in cardiac patients.

Brand Names

Voltaren, Voltaren Rapid, Fenac

Oral Routes

Tablets (25, 50 mg). Enteric Coated (50 mg). Sustained Release (75, 100 mg).

Parenteral

Ampoules (75 mg/3 mL) for IM only. Suppositories (100 mg) for PR.

Prescribing & PBS

Over The Counter (OTC 25mg). Prescription S4 for higher doses/injections.

Primary

Acute musculoskeletal pain, acute gout, renal colic, rheumatoid arthritis.

Clinical Place

Used for severe, sharp acute pain (like renal colic) where rapid anti-inflammatory action is required.