NSAID·Analgesia - Simple & NSAIDs

Diclofenac

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

PBSNSAIDVoltaren, Voltaren Rapid, Fenac50 mg EC tabletUNSCHEDULED+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

150 mg/day

Half-life

1-2 h

Caution: CV Risk

HIGHEST NSAID

Caution: GI Bleed

RISK

Cautions

Avoid / Cautions

Ischemic heart disease, previous stroke/TIA, NYHA Class II-IV heart failure, active GI ulcer, eGFR < 30. Pregnancy Category C. Do not use in 3rd trimester.

Where it stands

Rapid Summary

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.

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.

Formulation & Access

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.

Indications & Use

Primary

PBSTGA

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.

Quick reference

Class & Role

NSAID — Highly potent NSAID with slightly more selectivity for COX-2 than COX-1.

Route / Formulation

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

Usual Dose & Max

PO 50 mg TDS. Max 150 mg/day.

Key Indication Doses

Acute Pain / Arthritis: PO 50 mg TDS. Max 150 mg/day. Renal Colic (Hospital): IM 75 mg STAT deep intragluteal injection. OR PR 100 mg suppository. Topical Analgesia: Apply 1% or 2% gel Topical to affected joint QID.

Best Uses

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.

Key Risks

Cardiovascular: Significant, dose-dependent increased risk of myocardial infarction and stroke. Triggers acute heart failure via sodium retention. Gastrointestinal: Peptic ulceration and bleeding (despite leaning toward COX-2, GI toxicity remains high). Renal: AKI (vasoconstricts afferent arteriole). Hepatic: Rare but severe hepatotoxicity (highest risk among NSAIDs).

Key Interactions

DOACs, Warfarin, Clopidogrel (GI Bleeding). ACEi/ARB + Diuretic + Diclofenac = AKI. Lithium (massively raises lithium levels).

Monitoring

Ensure patient takes it with food. Strongly consider prophylactic PPI. Avoid prolonged courses (> 2 weeks) if possible due to CV risk. Check LFTs if used chronically for arthritis.

Clinical Pearl

For a patient writhing in agony from a kidney stone (renal colic), a 100mg Diclofenac suppository (PR) is often vastly superior to IV Morphine. It directly halts the prostaglandin-driven ureteric spasm.

Access

Voltaren, Voltaren Rapid, Fenac50 mg EC tablet

Brand: Voltaren, Voltaren Rapid, Fenac
Formulation: Tablets (25, 50 mg). Enteric Coated (50 mg). Sustained Release (75, 100 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

NSAID·Analgesia - Simple & NSAIDs

Diclofenac

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

PBSNSAIDVoltaren, Voltaren Rapid, Fenac50 mg EC tabletUNSCHEDULED+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

150 mg/day

Half-life

1-2 h

Caution: CV Risk

HIGHEST NSAID

Caution: GI Bleed

RISK

Cautions

Avoid / Cautions

Ischemic heart disease, previous stroke/TIA, NYHA Class II-IV heart failure, active GI ulcer, eGFR < 30. Pregnancy Category C. Do not use in 3rd trimester.

Where it stands

Rapid Summary

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.

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.

Formulation & Access

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.

Indications & Use

Primary

PBSTGA

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.

Quick reference

Class & Role

NSAID — Highly potent NSAID with slightly more selectivity for COX-2 than COX-1.

Route / Formulation

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

Usual Dose & Max

PO 50 mg TDS. Max 150 mg/day.

Key Indication Doses

Best Uses

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.

Key Risks

Key Interactions

DOACs, Warfarin, Clopidogrel (GI Bleeding). ACEi/ARB + Diuretic + Diclofenac = AKI. Lithium (massively raises lithium levels).

Monitoring

Ensure patient takes it with food. Strongly consider prophylactic PPI. Avoid prolonged courses (> 2 weeks) if possible due to CV risk. Check LFTs if used chronically for arthritis.

Clinical Pearl

Access

Voltaren, Voltaren Rapid, Fenac50 mg EC tablet

Brand: Voltaren, Voltaren Rapid, Fenac
Formulation: Tablets (25, 50 mg). Enteric Coated (50 mg). Sustained Release (75, 100 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.