other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lPREGNANCYAvoid unless the potential benefit outweighs
the risk. Avoid during the third trimester (risk of closure of
fetal ductus arteriosusin uteroand possibly persistent
pulmonary hypertension of the newborn); onset of labour
may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Amount in milk too small to be harmful.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.
lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid in severe impairment.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Diclofenac for pain and
inflammationwww.medicinesforchildren.org.uk/diclofenac-for-
pain-and-inflammationlMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Diclofenac potassium (Non-proprietary)
Diclofenac potassium 25 mgDiclofenac potassium 25 mg tablets|
28 tabletP£ 3. 87 DT = £ 3. 87
Diclofenac potassium 50 mgDiclofenac potassium 50 mg tablets|
28 tabletP£ 6. 18 – £ 7. 41
▶Voltarol Rapid(Novartis Pharmaceuticals UK Ltd)
Diclofenac potassium 50 mgVoltarol Rapid 50 mg tablets|
30 tabletP£ 7. 94 DT = £ 7. 94Diclofenac sodium
lINDICATIONS AND DOSE
Pain and inflammation in rheumatic disease including
juvenile idiopathic arthritis
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 6 months–17 years: 1. 5 – 2. 5 mg/kg twice daily, total
daily dose may alternatively be given in 3 divided
doses; maximum 150 mg per day
Postoperative pain
▶BY RECTUM
▶Child 6 months–17 years (body-weight 8–11 kg): 12. 5 mg
twice daily for maximum 4 days
▶Child 6 months–17 years (body-weight 12 kg and
above): 1 mg/kg 3 times a day (max. per dose 50 mg) for
maximum 4 days
Inflammation|Mild to moderate pain
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES, OR BY
RECTUM
▶Child 6 months–17 years: 0. 3 – 1 mg/kg 3 times a day
(max. per dose 50 mg)
DICLOMAX RETARD®
Pain and inflammation
▶BY MOUTH
▶Child 12–17 years: 1 capsule once daily
DICLOMAX SR®
Pain and inflammation
▶BY MOUTH
▶Child 12–17 years: 1 capsule 1 – 2 times a dayMOTIFENE®
Pain and inflammation
▶BY MOUTH
▶Child 12–17 years: 1 capsule 1 – 2 times a day
VOLTAROL®75MG SR TABLETS
Pain and inflammation
▶BY MOUTH
▶Child 12–17 years: 1 tablet 1 – 2 times a day
VOLTAROL®RETARD
Pain and inflammation
▶BY MOUTH
▶Child 12–17 years: 1 tablet once daily
VOLTAROL®SOLUTION FOR INJECTION
Postoperative pain
▶BY INTRAVENOUS INFUSION, OR BY DEEP INTRAMUSCULAR
INJECTION
▶Child 2–17 years: 0. 3 – 1 mg/kg 1 – 2 times a day for
maximum 2 days, for intramuscular injection, to be
injected into the gluteal muscle; maximum 150 mg per
daylUNLICENSED USENot licensed for use in children under
1 year.Suppositoriesnot licensed for use in children under
6 years except for use in children over 1 year for juvenile
idiopathic arthritis. Solid dose forms containing more than
25 mg not licensed for use in children.Injectionnot
licensed for use in children.
lCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.avoid injections
containing benzyl alcohol in neonates.avoid
suppositories in proctitis.cerebrovascular disease.history
of gastro-intestinal bleeding related to previous NSAID
therapy.history of gastro-intestinal perforation related to
previous NSAID therapy.history of recurrent gastro-
intestinal haemorrhage (two or more distinct episodes).
history of recurrent gastro-intestinal ulceration (two or
more distinct episodes).ischaemic heart disease.mild to
severe heart failure.peripheral arterial disease
▶With intravenous useDehydration.history of asthma.
history of confirmed or suspected cerebrovascular bleeding
.history of haemorrhagic diathesis.hypovolaemia.
operations with high risk of haemorrhage
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).coagulation defects.
connective-tissue disorders.Crohn’s disease (may be
exacerbated).history of cardiac failure.hypertension.left
ventricular dysfunction.oedema.risk factors for
cardiovascular events.ulcerative colitis (may be
exacerbated)
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.diarrhoea.
dizziness.gastrointestinal discomfort.gastrointestinal
disorders.headache.nausea.oedema.skin reactions.
rash (discontinue).vertigo.vomiting
▶UncommonChest pain.heart failure.myocardial
infarction.palpitations
▶Rare or very rareAcute kidney injury.agranulocytosis.
alopecia.anaemia.angioedema.anxiety.aplastic
anaemia.asthma.confusion.constipation.Crohn’s
disease.depression.disorientation.drowsiness.
dyspnoea.erectile dysfunction.haemolytic anaemia.
haemorrhage.hearing impairment.hepatic disorders.
hypersensitivity.hypertension.hypotension.irritability.
leucopenia.memory loss.meningitis aseptic (patients
with connective-tissue disorders such as systemic lupus
erythematosus may be especially susceptible).nephritis
tubulointerstitial.nephrotic syndrome.oral disorders.
pancreatitis.paraesthesia.photosensitivity reaction.
pneumonitis.proteinuria.psychotic disorder.renal652 Pain and inflammation in musculoskeletal disorders BNFC 2018 – 2019
Musculoskeletal system10