Diclofenac is a widely prescribed nonsteroidal anti-inflammatory drug (NSAID) renowned for its efficacy in managing pain and reducing inflammation. It functions by inhibiting cyclooxygenase enzymes, thereby decreasing the production of prostaglandins, which are mediators of pain and inflammatory responses. Available in multiple formulations—including oral tablets, topical gels, and injectable solutions—diclofenac offers versatile application across various medical conditions. Its robust pharmacokinetic profile ensures rapid onset of action and sustained therapeutic effects, making it a cornerstone in both acute and chronic pain management protocols. Healthcare professionals value its balance of potency and a generally manageable side effect profile when used appropriately.

Features

• Available in multiple formulations: oral (tablets, capsules), topical (gel, patch), and parenteral (injection)
• Potent inhibitor of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes
• Rapid absorption and onset of action, with peak plasma concentrations typically within 2–3 hours for oral forms
• Exhibits high protein binding (greater than 99%) and is metabolized hepatically
• Extended-release formulations allow for once-daily dosing, improving patient compliance
• Topical formulations provide localized therapy with minimal systemic exposure

Benefits

• Effectively reduces pain and inflammation associated with musculoskeletal disorders, such as osteoarthritis and rheumatoid arthritis
• Provides rapid relief from acute pain conditions, including postoperative pain and migraine attacks
• Helps improve mobility and functional capacity in patients with chronic inflammatory conditions
• Topical formulations minimize systemic side effects, offering a safer alternative for localized pain
• Supports reduced reliance on opioid analgesics for moderate pain management
• Contributes to enhanced quality of life through sustained control of inflammatory symptoms

Common use

Diclofenac is commonly prescribed for the management of pain and inflammation in a variety of conditions. It is frequently used in the treatment of osteoarthritis and rheumatoid arthritis to alleviate joint pain and stiffness. Additionally, it is indicated for ankylosing spondylitis, acute gout, and menstrual pain. In sports medicine and orthopedics, diclofenac is often employed for acute musculoskeletal injuries, such as sprains and strains. Topical formulations are particularly beneficial for localized pain, such as in osteoarthritis of superficial joints like the knees or hands. Off-label uses may include management of postoperative pain and certain types of headaches, though these should be guided by clinical evaluation.

Dosage and direction

Dosage of diclofenac must be individualized based on the specific formulation, indication, and patient factors such as age, renal function, and overall health. For oral tablets in adults, the typical dose for osteoarthritis is 100–150 mg per day, administered in divided doses. For rheumatoid arthritis, doses may range from 150–200 mg daily. Extended-release tablets are usually given once daily. Topical gel should be applied four times daily to the affected area, with careful attention to the recommended quantity (e.g., 4g per joint for lower extremities). Injectables are generally administered under medical supervision for acute pain. Always take diclofenac with food or milk to minimize gastrointestinal upset. Do not crush or chew extended-release formulations.

Precautions

Patients should use diclofenac with caution, particularly those with a history of gastrointestinal disorders, as NSAIDs can increase the risk of ulcers and bleeding. Renal function should be monitored in individuals with pre-existing kidney impairment, dehydration, or heart failure. Diclofenac may elevate cardiovascular risk, including myocardial infarction and stroke; thus, it should be used at the lowest effective dose for the shortest duration possible in patients with cardiovascular disease or risk factors. Elderly patients are more susceptible to adverse effects and require careful dosing. Avoid concomitant use with other NSAIDs or corticosteroids to reduce additive risks.

Contraindications

Diclofenac is contraindicated in patients with known hypersensitivity to diclofenac, aspirin, or other NSAIDs. It must not be used in individuals who have experienced asthma, urticaria, or allergic-type reactions after taking NSAIDs. Contraindications also include active peptic ulcer disease or gastrointestinal bleeding, severe heart failure, and third-trimester pregnancy due to risk of premature closure of the ductus arteriosus. Patients with severe hepatic impairment or those undergoing coronary artery bypass graft (CABG) surgery should avoid diclofenac.

Possible side effect

Common side effects of diclofenac include gastrointestinal symptoms such as nausea, dyspepsia, abdominal pain, and diarrhea. Headache, dizziness, and elevated liver enzymes may also occur. Serious adverse effects, though less common, include gastrointestinal bleeding or perforation, hepatotoxicity, hypertension, fluid retention, and renal impairment. Skin reactions like rash or photosensitivity can occur, and severe cutaneous reactions such as Stevens-Johnson syndrome are rare but possible. Topical formulations may cause local skin reactions, including dryness, itching, or redness at the application site.

Drug interaction

Diclofenac can interact with several medications, potentially altering their effects or increasing the risk of adverse events. Concurrent use with other NSAIDs or corticosteroids elevates the risk of gastrointestinal bleeding. It may reduce the efficacy of antihypertensive drugs, such as ACE inhibitors or diuretics, and increase lithium or digoxin levels by reducing renal clearance. Diclofenac can enhance the effects of warfarin and other anticoagulants, increasing bleeding risk. Use with caution alongside methotrexate or cyclosporine due to potential nephrotoxicity.

Missed dose

If a dose of diclofenac is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one, as this increases the risk of side effects. For topical formulations, apply the missed dose as soon as possible, but avoid applying two doses at the same time.

Overdose

Symptoms of diclofenac overdose may include nausea, vomiting, epigastric pain, gastrointestinal bleeding, drowsiness, dizziness, tinnitus, or seizures. In severe cases, acute renal failure, respiratory depression, or coma may occur. There is no specific antidote for diclofenac overdose; management is supportive and symptomatic. Gastric lavage or activated charcoal may be considered if ingestion was recent. Hemodialysis is not effective due to high protein binding. Seek immediate medical attention in case of suspected overdose.

Storage

Store diclofenac at room temperature, away from light, moisture, and heat. Keep oral formulations in their original container, tightly closed. Topical gels and patches should be stored at controlled room temperature and kept out of reach of children and pets. Do not freeze liquid formulations or expose to extreme temperatures. Always check expiration dates and discard any unused or expired medication properly, following local guidelines for medication disposal.

Disclaimer

This information is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. The use of diclofenac should be based on a thorough evaluation of the patient’s medical history, current health status, and potential risks and benefits. This document is not a substitute for professional medical guidance, diagnosis, or treatment.

Reviews

“Diclofenac has been instrumental in managing my rheumatoid arthritis flare-ups. The extended-release formulation allows all-day relief with minimal dosing.” — Patient with chronic inflammatory condition
“As a physician, I find diclofenac highly effective for acute musculoskeletal pain, particularly in its topical form for localized application with reduced systemic effects.” — Healthcare provider
“While effective, I experienced mild gastrointestinal discomfort initially, which subsided with dose adjustment and taking it with food.” — User report
“Prescribed for osteoarthritis knee pain, the topical gel provided significant improvement in mobility without the GI issues associated with oral NSAIDs.” — Long-term user