papillary necrosis.seizure.sensation abnormal.severe
cutaneous adverse reactions (SCARs).shock.sleep
disorders.stroke.taste altered.thrombocytopenia.
tremor.vasculitis.vision disorders
▶Frequency not knownFertility decreased female.fluid
retention.hallucination.malaise.optic neuritis.platelet
aggregation inhibition
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
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.
▶With intravenous useContra-indicated in moderate or severe
renal 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.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, dilute 75 mg with 100 – 500 mL Glucose 5 %or
Sodium Chloride 0. 9 % (previously buffered with 0. 5 mL
Sodium Bicarbonate 8. 4 % solutionorwith 1 mL Sodium
Bicarbonate 4. 2 % solution); give over 30 – 120 minutes.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Diclofenac for pain and
inflammationwww.medicinesforchildren.org.uk/diclofenac-for-
pain-and-inflammation
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: dispersible tablet, oral suspension, oral
solution
Gastro-resistant tablet
CAUTIONARY AND ADVISORY LABELS5, 25
▶Diclofenac sodium (Non-proprietary)
Diclofenac sodium 25 mgDiclofenac sodium 25 mg gastro-resistant
tablets| 28 tabletP£ 5. 49 – £ 8. 99 DT = £ 2. 02 | 84 tabletP
£ 1. 50 – £ 26. 97
Diclofenac sodium 50 mgDiclofenac sodium 50 mg gastro-resistant
tablets| 28 tabletP£ 4. 97 DT = £ 2. 25 | 84 tabletP£ 3. 00 –
£ 15. 00
▶Dicloflex(Dexcel-Pharma Ltd)
Diclofenac sodium 25 mgDicloflex 25 mg gastro-resistant tablets|
84 tabletP£ 4. 42
Diclofenac sodium 50 mgDicloflex 50 mg gastro-resistant tablets|
28 tabletP£ 2. 75 DT = £ 2. 25 (Hospital only)| 84 tabletP
£ 8. 05
▶Fenactol(Discovery Pharmaceuticals)
Diclofenac sodium 50 mgFenactol 50 mg gastro-resistant tablets|
100 tabletP£ 3. 70
Suppository
▶Diclofenac sodium (Non-proprietary)
Diclofenac sodium 100 mgDiclofenac 100 mg suppositories|
10 suppositoryP£ 3. 64 DT = £ 3. 64
▶Econac(AMCo)
Diclofenac sodium 100 mgEconac 100 mg suppositories|
10 suppositoryP£ 3. 04 DT = £ 3. 64
▶Voltarol(Novartis Pharmaceuticals UK Ltd)
Diclofenac sodium 12.5 mgVoltarol 12. 5 mg suppositories|
10 suppositoryP£ 0. 70 DT = £ 0. 70
Diclofenac sodium 25 mgVoltarol 25 mg suppositories|
10 suppositoryP£ 1. 24 DT = £ 1. 24
Diclofenac sodium 50 mgVoltarol 50 mg suppositories|
10 suppositoryP£ 2. 04 DT = £ 2. 04
Diclofenac sodium 100 mgVoltarol 100 mg suppositories|
10 suppositoryP£ 3. 64 DT = £ 3. 64
Solution for injection
EXCIPIENTS:May contain Benzyl alcohol, propylene glycol
▶Voltarol(Novartis Pharmaceuticals UK Ltd)
Diclofenac sodium 25 mg per 1 mlVoltarol 75 mg/ 3 ml solution for
injection ampoules| 10 ampouleP£ 9. 91 DT = £ 9. 91
Modified-release capsule
CAUTIONARY AND ADVISORY LABELS21 (does not apply to
Motifene®75 mg), 25
EXCIPIENTS:May contain Propylene glycol
▶Diclomax Retard(Galen Ltd)
Diclofenac sodium 100 mgDiclomax Retard 100 mg capsules|
28 capsuleP£ 8. 20 DT = £ 8. 20
▶Diclomax SR(Galen Ltd)
Diclofenac sodium 75 mgDiclomax SR 75 mg capsules|
56 capsuleP£ 11. 40 DT = £ 11. 40
▶Motifene(Daiichi Sankyo UK Ltd)
Diclofenac sodium 75 mgMotifene 75 mg modified-release capsules
| 56 capsuleP£ 8. 00 DT = £ 8. 00Etoricoxib 23-Nov-2016
lINDICATIONS AND DOSE
Pain and inflammation in osteoarthritis
▶BY MOUTH
▶Child 16–17 years: 30 mg once daily, increased if
necessary to 60 mg once daily
Pain and inflammation in rheumatoid arthritis|
Ankylosing spondylitis
▶BY MOUTH
▶Child 16–17 years: 60 mg once daily, increased if
necessary to 90 mg once daily
Acute gout
▶BY MOUTH
▶Child 16–17 years: 120 mg once daily for maximum
8 dayslCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.cerebrovascular
disease.inflammatory bowel disease.ischaemic heart
disease.mild to severe heart failure.peripheral arterial
disease.uncontrolled hypertension (persistently above
140/90 mmHg)
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).coagulation defects.
connective-tissue disorders.Crohn’s disease (may be
exacerbated).dehydration.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 commonArrhythmias.asthenia.
bronchospasm.constipation.diarrhoea.dizziness.fluid
retention.gastrointestinal discomfort.gastrointestinal
disorders.headache.hypertension.increased risk of
infection.influenza like illness.nausea.oedema.oral
ulceration.palpitations.skin reactions.vomiting
▶UncommonAlertness decreased.anaemia.angina pectoris
.anxiety.appetite abnormal.cerebrovascular
insufficiency.chest pain.congestive heart failure.
conjunctivitis.cough.depression.drowsiness.dry mouthBNFC 2018 – 2019 Pain and inflammation in musculoskeletal disorders 653
Musculoskeletal system10