THE USUAL DOSE OF DICLOFENAC SODIUM BY MOUTH OR RECTALLY IS 75 TO 150 MG DAILY IN DIVIDED DOSES. IN THE UK THE MAXIMUM DOSE REGARDLESS OF ROUTE OR INDICATION IS 150 MG DAILY; HOWEVER, IN THE USA A MAXIMUM ORAL DOSE OF 200 MG DAILY IS ALLOWED IN THE TREATMENT OF RHEUMATOID ARTHRITIS. MODIFIED-RELEASE PREPARATIONS OF DICLOFENAC SODIUM ARE AVAILABLE FOR ORAL USE. DICLOFENAC HAS ALSO BEEN GIVEN IN EQUIVALENT DOSES BY MOUTH AS THE FREE ACID IN DISPERSIBLE PREPARATIONS FOR SHORT-TERM TREATMENT UP TO 3 MONTHS LONG.
DICLOFENAC SODIUM MAY ALSO BE GIVEN BY DEEP INTRAMUSCULAR INJECTION INTO THE GLUTEAL MUSCLE IN A DOSE OF 75 MG ONCE DAILY OR, IF REQUIRED IN SEVERE CONDITIONS, 75 MG TWICE DAILY. DICLOFENAC SODIUM MAY ALSO BE GIVEN AS A CONTINUOUS OR INTERMITTENT INTRAVENOUS INFUSION IN GLUCOSE 5% OR SODIUM CHLORIDE 0.9% (BOTH PREVIOUSLY BUFFERED WITH SODIUM BICARBONATE). FOR THE TREATMENT OF POSTOPERATIVE PAIN A DOSE OF 75 MG MAY BE GIVEN OVER 30 TO 120 MINUTES. THE DOSE MAY BE REPEATED IF NECESSARY AFTER 4 TO 6 HOURS. TO PREVENT POSTOPERATIVE PAIN, 25 TO 50 MG DICLOFENAC SODIUM MAY BE GIVEN AFTER SURGERY OVER 15 TO 60 MINUTES FOLLOWED BY 5 MG/HOUR TO A MAXIMUM OF 150 MG DAILY. THE MAXIMUM PERIOD RECOMMENDED FOR PARENTERAL USE IS 2 DAYS. DICLOFENAC SODIUM IS ALSO USED INTRAMUSCULARLY IN RENAL COLIC IN A DOSE OF 75 MG REPEATED ONCE AFTER 30 MINUTES IF NECESSARY.
IN CHILDREN 1 TO 12 YEARS OLD THE LICENSED UK DOSE BY MOUTH OR RECTALLY FOR JUVENILE IDIOPATHIC ARTHRITIS IS 1 TO 3 MG/KG DAILY IN DIVIDED DOSES. IN CHILDREN 6 TO 12 YEARS OLD DICLOFENAC SODIUM MAY ALSO BE GIVEN RECTALLY FOR THE TREATMENT OF ACUTE POSTOPERATIVE PAIN, EITHER ALONE OR AS AN ADJUNCT TO OPIATE THERAPY; A USUAL DOSE IS 1 TO 2 MG/KG DAILY IN DIVIDED DOSES FOR A MAXIMUM OF 4 DAYS. THE BNFC SUGGESTS SLIGHTLY DIFFERENT DOSES: IN THE MANAGEMENT OF RHEUMATIC DISEASE, INCLUDING JUVENILE IDIOPATHIC ARTHRITIS, IN CHILDREN FROM 6 MONTHS OF AGE, IT RECOMMENDS A DOSE OF 3 TO 5 MG/KG DAILY BY MOUTH, IN 3 OR 4 DIVIDED DOSES, UP TO A MAXIMUM OF 150 MG DAILY. FOR RELIEF OF PAIN AND INFLAMMATION IN, FOR EXAMPLE, SOFT-TISSUE DISORDERS, THE RECOMMENDED DOSE IN CHILDREN FROM 6 MONTHS OF AGE IS 0.3 TO 1 MG/KG GIVEN THREE TIMES DAILY BY MOUTH OR RECTALLY; CHILDREN 2 YEARS OF AGE AND OLDER MAY BE GIVEN A SIMILAR DOSE ONCE OR TWICE DAILY BY INTRAVENOUS OR DEEP INTRAMUSCULAR (GLUTEAL) INJECTION INSTEAD, FOR UP TO 2 DAYS. AGAIN, A MAXIMUM DAILY DOSE OF 150 MG SHOULD NOT BE EXCEEDED.
DICLOFENAC SODIUM IS USED AS A 0.1% OPHTHALMIC SOLUTION IN A NUMBER OF SITUATIONS:
FOR THE PREVENTION OF INTRA-OPERATIVE MIOSIS DURING CATARACT SURGERY, IT IS INSTILLED IN THE APPROPRIATE EYE 4 TIMES DURING THE 2 HOURS BEFORE SURGERY
FOR THE TREATMENT OF POSTOPERATIVE INFLAMMATION AFTER CATARACT SURGERY, IT IS INSTILLED 4 TIMES DAILY FOR UP TO 28 DAYS STARTING 24 HOURS AFTER SURGERY
FOR THE CONTROL OF POST-PHOTOREFRACTIVE KERATECTOMY PAIN, IT IS INSTILLED TWICE IN THE HOUR BEFORE SURGERY, THEN ONE DROP TWICE AT 5-MINUTE INTERVALS IMMEDIATELY AFTER THE PROCEDURE, AND THEN EVERY 2 TO 5 HOURS WHILE AWAKE FOR UP TO 24 HOURS
FOR PAIN CONTROL AFTER ACCIDENTAL TRAUMA ONE DROP IS INSTILLED 4 TIMES DAILY FOR UP TO 2 DAYS
IN THE TREATMENT OF INFLAMMATION AND DISCOMFORT AFTER STRABISMUS SURGERY ONE DROP IS INSTILLED 4 TIMES DAILY FOR THE FIRST WEEK; THIS IS REDUCED TO 3 TIMES DAILY IN THE SECOND WEEK, TWICE DAILY IN THE THIRD WEEK, AND AS REQUIRED FOR THE FOURTH WEEK
FOR THE CONTROL OF INFLAMMATION AFTER ARGON LASER TRABECULOPLASTY ONE DROP IS INSTILLED 4 TIMES DURING THE 2 HOURS BEFORE THE PROCEDURE FOLLOWED BY ONE DROP 4 TIMES DAILY FOR UP TO 7 DAYS AFTER THE PROCEDURE
FOR THE TREATMENT OF PAIN AND DISCOMFORT AFTER RADIAL KERATOTOMY ONE DROP IS GIVEN BEFORE SURGERY FOLLOWED BY ONE DROP IMMEDIATELY AFTER SURGERY AND THEN ONE DROP 4 TIMES DAILY FOR UP TO 2 DAYS
TO RELIEVE SYMPTOMS OF SEASONAL ALLERGIC CONJUNCTIVITIS ONE DROP IS INSTILLED 4 TIMES DAILY AS NECESSARY
A TOPICAL SOLUTION OF DICLOFENAC SODIUM 1.6% IS ALSO AVAILABLE FOR THE TREATMENT OF OSTEOARTHRITIS; IT IS APPLIED IN SMALL ALIQUOTS TO ACHIEVE A TOTAL OF 20 TO 40 DROPS, REPEATED FOUR TIMES DAILY. DICLOFENAC IS ALSO USED IN THE MANAGEMENT OF ACTINIC KERATOSES; IT IS APPLIED TWICE DAILY AS DICLOFENAC SODIUM GEL 3% FOR 60 TO 90 DAYS BUT THE OPTIMUM THERAPEUTIC EFFECT MAY NOT BE SEEN UNTIL 30 DAYS AFTER THE END OF TREATMENT. DICLOFENAC EPOLAMINE IS ALSO USED TOPICALLY AS A PLASTER CONTAINING THE EQUIVALENT OF 1% OF DICLOFENAC SODIUM FOR LOCAL SYMPTOMATIC PAIN RELIEF IN ANKLE SPRAIN AND EPICONDYLITIS. IN THE TREATMENT OF ANKLE SPRAIN, 1 PLASTER IS APPLIED ONCE DAILY FOR A MAXIMUM OF 3 DAYS AND FOR EPICONDYLITIS, 1 PLASTER IS APPLIED TWICE DAILY FOR A MAXIMUM OF 14 DAYS.
DICLOFENAC IS AVAILABLE IN COMBINATION WITH MISOPROSTOL FOR PATIENTS AT RISK OF NSAID-INDUCED PEPTIC ULCERATION.