Medication Guide App

Diclofenac

Pronunciation: dye-KLOE-fen-ak
Class: NSAID

Trade Names

Cambia
- Powder for solution, oral 50 mg (as potassium)

Cataflam
- Tablets, oral 50 mg (as potassium)

Diclofenac
- Tablets, delayed-release, oral 25 mg (as sodium)
- Tablets, delayed-release, oral 50 mg (as sodium)

Flector
- Patch, transdermal 180 mg (as epolamine)

Pennsaid
- Solution, topical 1.5% (as sodium)

Solaraze
- Gel, topical 3% (as sodium)

Voltaren
- Gel, topical 1% (as sodium)
- Tablets, delayed-release, oral 75 mg (as sodium)
- Solution, ophthalmic 0.1% (as sodium)

Voltaren-XR
- Tablets, ER, oral 100 mg (as sodium)

Zipsor
- Capsules, oral 25 mg (as potassium)

Apo-Diclo (Canada)
Apo-Diclo Rapide (Canada)
Apo-Diclo SR (Canada)
Novo-Difenac (Canada)
Novo-Difenac K (Canada)
Novo-Difenac SR (Canada)
Nu-Diclo (Canada)
Nu-Diclo-SR (Canada)
PMS-Diclofenac (Canada)
PMS-Diclofenac SR (Canada)
Sandoz Diclofenac (Canada)
Sandoz Diclofenac Rapide (Canada)
Sandoz Diclofenac SR (Canada)
Voltaren Ophtha (Canada)
Voltaren Rapide (Canada)

Pharmacology

Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

Pharmacokinetics

Absorption

Bioavailability is approximately 50% because of first-pass metabolism (oral doseforms). Food decreases T max and C max .

Immediate-release capsules and tablets

T max is approximately 0.5 to 1 h.

ER tablets

T max is approximately 5.3 h.

Delayed-release tablets (50 mg dose)

T max is approximately 2.3 h.

Flector

Following a single application of the patch on the upper inner arm, C max of 0.7 to 6 ng/mL was noted between 10 and 20 h of application. With twice-daily application of patch, plasma concentrations ranged from 1.3 to 8.8 ng/mL after 5 days.

Pennsaid

Following application of 40 drops 4 times daily for 7 days, mean AUC is 695.4 ng•h/mL, mean C max is 19.4 ng/mL, and mean T max is 4 h.

Solaraze

Following application of 2 g 3 times daily for 6 days, mean AUC is 9 ng•h/mL, mean C max is 4 ng/mL, and mean T max is 4.5 h.

Voltaren gel

C max with application of 160 mg/day is 15 ng/mL and with application of 480 mg/day is 54 ng/mL. T max is 14 h with the application of 160 mg/day and 10 h with the application of 480 mg/day. The amount reaching the systemic circulation is 158 times lower with 160 mg/day compared with oral treatment.

Distribution

More than 99% protein bound (albumin). Vd is approximately 1.4 L/kg (oral).

Metabolism

Undergoes hepatic metabolism. Five metabolites have been identified.

Elimination

Approximately 65% is excreted in the urine and 35% in the bile as conjugates of unchanged diclofenac plus metabolites. The half-life is 1 to 2 h. Plasma elimination half-life after application of Flector is approximately 12 h.

Special Populations

Renal Function Impairment

No differences in pharmacokinetics have been detected in studies in patients with renal impairment.

Hepatic Function Impairment

Because hepatic metabolism accounts for almost 100% of diclofenac elimination, patients with hepatic disease may require reduced doses.

Children

Pharmacokinetics have not been studied.

Race

Pharmacokinetic differences because of race have not been identified.

Indications and Usage

Oral

Acute and long-term use in the relief of signs and symptoms of ankylosing spondylitis (delayed-release tablets); acute treatment of migraine attacks with or without aura in adults (oral solution); relief of mild to moderate pain (immediate-release capsules and tablets); relief of signs and symptoms of osteoarthritis and rheumatoid arthritis (immediate-release, ER, and delayed-release tablets); treatment of primary dysmenorrhea (immediate-release tablets).

Ophthalmic

Treatment of postoperative inflammation after cataract removal; temporary relief of pain and photophobia following corneal refractive surgery.

Flector

Treatment of acute pain because of minor strains, sprains, and contusions.

Pennsaid

For the treatment of signs and symptoms of osteoarthritis of the knee(s) only.

Solaraze

Treatment of actinic keratosis.

Voltaren gel

Treatment of pain of osteoarthritis or joint pain amenable to topical treatment (eg, knees, hands).

Unlabeled Uses

Treatment of juvenile idiopathic arthritis; treatment of postherpetic neuralgia.

Contraindications

Treatment of perioperative pain in the setting of coronary artery bypass graft surgery; patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or another NSAID; hypersensitivity to diclofenac or any component of the product. Do not apply topical patch to nonintact or damaged skin regardless of the cause (eg, burns or wounds, eczema, exudative dermatitis, infected lesion).

Dosage and Administration

Different tablet formulations of diclofenac are not necessarily bioequivalent.

Actinic Keratosis
Adults

Solaraze Apply gel to lesions twice daily. The recommended duration of treatment is 60 to 90 days.

Analgesia
Adults Immediate-release capsules

PO 25 mg 4 times daily.

Immediate-release tablets

PO 50 mg 3 times daily; may give initial dose of 100 mg if needed.

Ankylosing Spondylitis
Adults

PO Delayed-release tablets 100 to 125 mg/day administered as 25 mg 4 times daily, with additional 25 mg at bedtime, if necessary.

Migraine
Adults

PO Oral solution 50 mg as a one-time dose.

Minor Strains, Sprains, and Contusions
Adults

Topical patch Apply 1 patch to most painful area twice daily.

Osteoarthritis
Adults Immediate-release, delayed-release tablets

PO 100 to 150 mg/day in divided doses.

ER tablets

PO 100 mg daily.

Pennasid

40 drops per knee 4 times per day.

Voltaren gel

Using the dosing card supplied in the product carton, apply up to the 2 or 4 g line (2 g for elbows, wrist, or hand; 4 g for each knee, ankle, or foot). Apply 4 times daily by gently massaging gel into the skin, ensuring application to the entire affected area. Do not apply more than 8 g/day to any single joint of the upper extremities or more than 16 g/day to any single joint of the lower extremities. Do not apply more than 32 g/day over all affected joints.

Primary dysmenorrhea
Adults

PO Immediate-release tablets 50 mg 3 times daily; may give initial dose of 100 mg if needed.

Rheumatoid Arthritis
Adults Immediate-release, delayed-release tablets

PO 150 to 200 mg/day in divided doses.

ER tablets

PO 100 mg daily. If response is unsatisfactory, the dosage may be increased to 100 mg twice daily.

Ophthalmic
Cataract Surgery

1 drop in affected eye 4 times daily beginning 24 h after cataract surgery and continuing during the first 2 wk of postoperative period.

Corneal Refractive Surgery

1 or 2 drops within 1 h prior to corneal refractive surgery; then, within 15 min after surgery, apply 1 or 2 drops to the operative eye and continue 4 times daily for up to 3 days.

General Advice

  • ER and delayed-release tablets
  • Advise patient to swallow whole. Do not break, cut, crush, or chew tablet.
  • Flector
  • Do not apply to damaged or nonintact skin.
  • Do not wear when bathing or showering.
  • Wash hands after applying, handling, or removing the patch.
  • Avoid contact with eyes.
  • Ophthalmic solution
  • For ophthalmic use only.
  • If using other topical ophthalmic drugs, separate each medication by at least 5 min. Instill ophthalmic ointment last.
  • Oral solution
  • Empty contents of 1 packet into a cup with 1 to 2 oz (30 to 60 mL) of water and mix well. The solution should be used immediately. Liquids other than water should not be used.
  • Administration with food may cause a reduction in effectiveness.
  • Pennsaid
  • Apply to clean, dry skin. Avoid showering or bathing for at least 30 min after application. Wash and dry hands after use.
  • Do not apply to open wounds. Avoid contact with eyes and mucous membranes.
  • Do not apply external heat and/or occlusive dressings to treated knees. Avoid wearing clothing over the treated knees or applying sunscreen, insect repellant, lotion, moisturizer, cosmetics, or other topical medications until the area is dry.
  • Protect the treated area from sunlight.
  • Solaraze
  • For dermatological use only.
  • Using gloves, gently smooth onto affected skin. Apply gel to adequately cover each lesion. Do not apply to open skin wounds, infections, or exfoliative dermatitis.
  • Avoid contact with the eyes, mouth, and other mucous membranes.
  • The safety of the concomitant use of sunscreens, cosmetics, or other topical medications is unknown.
  • Voltaren topical gel
  • Do not apply to open wounds.
  • Avoid contact with eyes and mucous membranes.
  • Do not apply heat or occlusive dressing to treated joint.
  • Avoid exposure of treated joint to sunlight.
  • Do not use sunscreens, cosmetics, lotions, moisturizers, insect repellants, or other topical medications on the same site.
  • Avoid wearing clothing or gloves for at least 10 min after application.
  • Avoid showering for at least 1 h after application.
  • If used on the hand(s) for treatment, do not wash the treated hand(s) for at least 1 h after the application.

Storage/Stability

Immediate-release, delayed-release, and ER tablets

Do not store at temperatures higher than 86°F. Protect from moisture.

Immediate-release capsules, oral solution

Store between 59° and 86°F. Protect capsules from moisture.

Ophthalmic solution

Store between 59° and 77°F. Protect from light.

Flector

Store between 59° and 86°F.

Pennsaid , Solaraze , and Voltaren gel

Store between 59° and 86°F. Do not freeze. Protect from heat.

Drug Interactions

ACE inhibitors

Antihypertensive effect of ACE inhibitors may be diminished. In addition, the risk of nephrotoxicity associated with ACE inhibitors or diclofenac may be increased. Closely monitor BP. If BP control decreases, it may be necessary to discontinue diclofenac. Periodic measurement of renal function may be necessary.

Alcohol

The risk of GI bleeding may be increased. Use with caution.

Aminoglycosides (eg, gentamicin)

Aminoglycoside concentrations may be elevated, increasing the risk of adverse reactions (eg, acute renal insufficiency). If coadministration cannot be avoided, reduce the aminoglycoside dose before starting diclofenac. Monitor renal function and aminoglycoside serum concentrations and adjust the dose as needed.

Antiplatelet agents (eg, clopidogrel)

The risk of bleeding may be increased. Use with caution. Closely monitor for signs of bleeding.

Aspirin

Protein binding of diclofenac may be reduced; in addition, the risk of gastric erosion and bleeding may be increased. The clinical importance of this interaction is not known; however, as with other NSAIDs, coadministration is not generally recommended because of the potential of increased adverse effects.

Azole antifungal agents (eg, fluconazole)

Diclofenac plasma concentrations may be elevated, increasing the risk of adverse reactions. Observe the clinical response of the patient and adjust the diclofenac dose as needed.

Corticosteroids (eg, prednisone)

The risk of GI bleeding may be increased. Use with caution. Advise patients about the signs and symptoms of GI bleeding.

Cyclosporine

The nephrotoxicity of both agents may be increased. Use with caution and closely monitor for nephrotoxicity.

Food Diclofenac potassium

The extent of diclofenac potassium absorption is not affected when diclofenac potassium is taken with food; however, the rate of absorption is reduced by food, as indicated by a delay in onset and a decrease in C max .

Diclofenac sodium

Food has no effect on the extent of diclofenac absorption; however, there usually is a 1- to 4.5-hour delay in the onset of absorption and a reduction in C max of less than 20%.

Oral solution

High-fat food had no effect on the extent of diclofenac potassium absorption; however, there was a reduction in C max of approximately 70% after a high-fat meal. Decreased C max may be associated with decreased effectiveness. Taking diclofenac potassium oral solution with food may cause a reduction in effectiveness compared with taking it on an empty stomach.

Furosemide, thiazide diuretics

May inhibit diuretic and antihypertensive effects. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with NSAIDs, closely observe the patient for signs of renal failure, as well as to ensure diuretic efficacy.

Heparin

Risk of hemorrhagic adverse reactions may be increased. Closely monitor coagulation status and adjust the heparin dosage accordingly.

Hepatotoxic agents (eg, acetaminophen, certain antibiotics [eg, aminoglycosides (eg, gentamicin)], antiepileptic agents)

The risk of hepatotoxicity may be increased. Use with caution. Closely monitor for signs and symptoms of hepatotoxicity.

Hibiscus sabdariffa

Diclofenac urinary excretion may be reduced, increasing diclofenac concentrations and risk of adverse reactions. Patients taking diclofenac should avoid beverages made from Hibiscus sabdariffa flowers.

Lithium

May decrease lithium Cl, increasing lithium concentrations and risk of toxicity. These effects have been attributed to inhibition of renal prostaglandin synthesis by the NSAID. Closely monitor for signs of lithium toxicity.

Methotrexate

May increase methotrexate levels. Use with caution.

Quinolones (eg, levofloxacin)

Risk of CNS stimulation and seizures from quinolones may be increased. In addition, quinolone plasma concentrations may be increased. Use with caution.

Serotonin norepinephrine reuptake inhibitors (eg, venlafaxine), SSRIs (eg, fluoxetine)

Risk of upper GI bleeding may be increased. Use with caution. Closely monitor for signs of GI bleeding. Advise patients about the signs and symptoms of GI bleeding.

Smoking

The risk of GI bleeding may be increased. Use with caution.

Tenofovir

Pharmacologic and toxic effects (eg, nephrotoxicity) of tenofovir may be increased. Use with caution. Consider use of an analgesic other than an NSAID.

Triamterene

Coadministration of diclofenac and triamterene may cause a sudden onset of nephrotoxicity. If renal function deteriorates during coadministration of these agents, consider stopping one or both drugs.

Warfarin

May increase risk of gastric erosion and bleeding. Closely monitor coagulation status and adjust the warfarin dosage accordingly. Monitor for signs of GI bleeding. Advise patients about the signs and symptoms of GI bleeding.

Adverse Reactions

Cardiovascular

Oral

Arrhythmia, CHF, hypertension, hypotension, MI, syncope, tachycardia.

Solaraze

Hypertension (2%).

CNS

Oral

Dizziness, headache (1% to 10%); somnolence (3%); coma, hallucinations, meningitis.

Ophthalmic

Dizziness, headache, insomnia (3% or less).

Solaraze

Headache (7%); asthenia, hypokinesia (2%); migraine (1%).

Dermatologic

Oral

Pruritus, rash (1% to 10%); increased sweating (1%); angioedema, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, TEN.

Flector

Application-site dryness, atrophy, discoloration, erythema, hyperhidrosis, irritation, vesicles (4%); dermatitis (2%).

Pennsaid

Rash (3%); dry skin, ecchymosis, pruritus (2%).

Solaraze

Pruritus, rash (4%); dry skin (3%); contact dermatitis, skin ulcer (2%); pain (1%).

EENT

Ophthalmic

Lacrimation complaints (30%); keratitis (28%); elevated IOP, transient ocular burning and stinging (15%); abnormal vision, acute elevated IOP, blurred vision, conjunctivitis, corneal deposits, corneal edema, corneal lesions, corneal opacity, discharge, eyelid swelling, injection, iritis, irritation, itching, lacrimation disorder, ocular allergy, redness (5% or less); rhinitis (3% or less); corneal erosion, corneal infiltrates, corneal perforation, corneal thinning, corneal ulceration, epithelial breakdown, superficial punctuate keratitis (postmarketing).

Oral

Tinnitus (1% to 10%).

Solaraze

Conjunctivitis (4%); eye pain (2%).

GI

Ophthalmic

Abdominal pain, nausea, vomiting (3% or less).

Oral

Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, GI ulcers (gastric/duodenal), gross bleeding/perforation, heartburn, nausea, vomiting (1% to 10%); hematemesis, hepatitis, jaundice.

Flector

Nausea, constipation, diarrhea, dry mouth, gastritis, upper abdominal pain, vomiting (3%); dysgeusia (2%).

Pennsaid

Dyspepsia (8%); abdominal pain (6%); diarrhea, flatulence, nausea (4%); constipation (3%).

Solaraze

Abdominal pain, diarrhea, dyspepsia (2%).

Genitourinary

Oral

Interstitial nephritis, renal failure.

Solaraze

Hematuria (2%).

Hematologic-Lymphatic

Oral

Anemia, increased bleeding time (1% to 10%); agranulocytosis, aplastic anemia, hemolytic anemia, lymphadenopathy, pancytopenia, thrombocytopenia.

Hepatic

Oral

Elevated liver enzymes (1% to 10%); liver failure.

Local

Pennsaid

Dry skin (32%); contact dermatitis (9%); pruritus (4%); contact dermatitis with vesicles (2%).

Solaraze

Application-site reaction (84%); pruritus (52%); rash (46%); contact dermatitis (33%); pain (30%); dry skin (27%); exfoliation (24%); paresthesia (20%); edema, vesiculobullous rash (4%); hyperesthesia, photosensitivity reaction (3%); alopecia (2%); acne (1%).

Voltaren gel

Application-site reaction (7%); application-site dermatitis (4%).

Metabolic-Nutritional

Oral

Edema (1% to 10%).

Solaraze

Increased CPK (4%); increased AST (3%); increased ALT (2%); hypercholesterolemia, hyperglycemia (1%).

Musculoskeletal

Solaraze

Back pain (4%); myalgia (3%); arthralgia, arthrosis, neck pain (2%).

Renal

Oral

Abnormal renal function (1% to 10%).

Respiratory

Pennsaid

Sinusitis (1%).

Solaraze

Asthma, dyspnea, pneumonia, sinusitis (2%).

Ophthalmic

Dyspnea, exacerbation of asthma.

Miscellaneous

Oral

Death.

Ophthalmic

Asthenia, chills, facial edema, fever, pain, viral infection (3% or less).

Pennsaid

Edema, infection (3%); paresthesia (2%); halitosis (1%).

Solaraze

Flu syndrome (10%); chest pain, pain (2%).

Precautions

Warnings

NSAIDs may cause an increased risk of serious CV thrombotic events, MI, and stroke, which can be fatal. This risk may increase with length of therapy. Patients with CV disease or risk factors for CV disease may be at greater risk. Diclofenac is contraindicated for treatment of perioperative pain in the setting of coronary artery bypass graft surgery.

NSAIDs cause an increased risk of serious GI adverse reactions, including bleeding, inflammation, perforation of the stomach or intestines, and ulceration, which can be fatal. These events can occur any time during use and without warning symptoms. Elderly patients are at greater risk of serious GI events.


Monitor

Monitor for signs and symptoms of GI bleeding. Closely monitor BP during initiation of treatment and throughout the course of therapy. Carefully monitor patients who may be adversely affected by alterations in platelet function (eg, patients with coagulation disorders, patients receiving anticoagulant therapy). Obtain baseline assessments of pain and ability to perform activities of daily living. Ensure CBC, serum electrolytes, and serum transaminases are evaluated periodically during prolonged therapy. Monitor patient for signs and symptoms of hepatic function impairment. If noted, discontinue therapy immediately. Note dark, tarry stools; epigastric pain; indigestion; or unusual bleeding or bruising. If used in patients with advanced renal disease, monitor renal function. Monitor refractive stability for 1 year following corneal refractive procedures in patients treated with the ophthalmic solution.

Check hemoglobin or hematocrit in patients on long-term treatment if they exhibit signs or symptoms of anemia.


Pregnancy

Category C (immediate-release capsules and tablets, ER tablets, oral solution, ophthalmic solution, topical patch, delayed-release tablets, Pennsaid , Voltaren gel). Category B ( Solaraze topical gel). Can cause premature closure of the ductus arteriosus; avoid in late pregnancy.

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

Use with caution.

Renal Function

Not recommended in patients with advanced renal disease.

Hepatic Function

Because hepatic metabolism accounts for almost 100% of diclofenac elimination, consider diclofenac use in patients with hepatic impairment only if the benefits outweigh the risks.

Special Risk Patients

Use with caution in patients with fluid retention, heart failure, or hypertension.

Anaphylactoid reactions

Do not give diclofenac to patients with the aspirin triad, which typically occurs in patients with asthma who experience rhinitis with or without nasal polyps, or those who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs.

Anemia

Anemia has been reported and may be the result of fluid retention, occult or gross GI bleeding, or an incompletely described effect on erythropoiesis.

Asthma

Patients with asthma may have aspirin-sensitive asthma, which may be associated with severe and sometimes fatal bronchospasm. Do not administer diclofenac to patients with this type of aspirin sensitivity because of possible cross-reactivity.

Bleeding

There have been reports that ocularly applied NSAIDs may cause increased bleeding of ocular tissue in conjunction with surgery.

Dehydration

Use with caution when initiating treatment in patients with considerable dehydration.

Eye exposure

Avoid contact of diclofenac topical products with the eyes and mucosa. If eye contact occurs, immediately wash the eye with water or saline. A health care provider should be contacted if irritation persists for more than 1 h.

Hepatic effects

Elevations of 1 or more LFTs may occur in patients taking diclofenac. Cases of severe hepatic reactions, including liver necrosis, jaundice, fulminant hepatitis with or without jaundice, and liver failure, have been reported postmarketing.

Hypertension

New hypertension or worsening of preexisting hypertension, either of which may contribute to increased risk of CV events, may occur.

Inflammation

The activity of diclofenac in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting infectious complications of presumed noninfectious, painful conditions.

Phenylketonurics

Diclofenac oral solution contains aspartame equivalent to phenylalanine 25 mg per packet.

Platelet effects

NSAIDs inhibit platelet aggregation and have been reported to prolong bleeding time.

Renal effects

Renal papillary necrosis and other renal injury may occur with long-term use. Patients at greatest risk for renal toxicity are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics or ACE inhibitors, and elderly patients.

Skin reactions

Serious and sometimes fatal skin adverse reactions, including exfoliative dermatitis, Stevens-Johnson syndrome, and TEN, may occur.

Overdosage

Symptoms

Acute renal failure, anaphylactoid reactions, coma, drowsiness, epigastric pain, GI bleeding, hypertension, lethargy, nausea, respiratory depression, vomiting.

Patient Information

  • Encourage patients to read the NSAID Medication Guide that accompanies each prescription dispensed.
  • Advise patient to take prescribed dose without regard to meals, but to take with food, milk, or antacids if stomach upset occurs.
  • Advise patient not to cut, crush, chew, or break tablets, and to swallow whole with a full glass of water.
  • Caution patient to avoid alcohol, aspirin-containing medications, and smoking while taking this drug.
  • Caution patient to avoid drug late in pregnancy because it may cause premature closure of the ductus arteriosus.
  • Inform patients that NSAIDs may cause serious CV effects, such as MI or stroke, which may result in hospitalization or even death.
  • Advise patient to seek emergency medical assistance if any of the following occur: chest pain, shortness of breath or trouble breathing, slurred speech, swelling of the face or throat, weakness in one part or on one side of body.
  • Inform patients that NSAIDs can cause GI discomfort, and, rarely, more serious GI adverse effects, such as ulcers and bleeding, which may result in hospitalization and even death.
  • Inform patients that NSAIDs can cause serious skin adverse reactions, such as exfoliative dermatitis, Stevens-Johnson syndrome, and TEN, which may result in hospitalization and even death. Advise patients to be alert for skin rash, skin blisters, fever, and itching, and to seek medical advice if any of these occur. Advise patients to stop diclofenac immediately and contact their health care provider if any type of skin rash develops.
  • Advise patient to discontinue drug and notify health care provider if any of the following occur: changes in urine patterns, fatigue, fever, GI upset, joint pain, persistent nausea, persistent or recurrent black stools, unusual bleeding or bruising, visual disturbances, weight gain or edema, yellowing of the skin or eyes.
  • Advise patient to avoid unnecessary exposure to sunlight or tanning lamps and to use sunscreen and wear protective clothing to avoid photosensitivity reactions.
  • Ophthalmic solution
  • Remind patient that eye drops are for use in the eye only.
  • Teach patient proper technique for instilling eye drops: wash hands; do not allow dropper to touch eye; tilt head back, look up and pull lower eyelid down, then instill prescribed number of drops. Close eye for 2 to 3 min and apply gentle pressure to bridge of nose for 1 to 2 min. Do not rub eye.
  • Advise patient not to touch top of dropper bottle to eye, fingers, or any other surface.
  • Advise patient that if more than 1 topical ophthalmic drug is being used, administer the drugs at least 5 min apart. Administer ointment last.
  • Except for use of bandage hydrogel soft contact lens during first 3 days after refractive surgery, advise patients wearing soft contact lenses not to use the ophthalmic solution.
  • Inform patient that temporary stinging and burning are the most common adverse reactions and to contact health care provider if these occur and are bothersome.
  • Advise patient to contact eye doctor if eye or eyelid inflammation is noted, or if eye symptoms do not improve or they worsen.
  • Instruct patient wearing contact lenses to remove lenses when instilling eye drops.
  • Pennsaid , Solaraze , Voltaren gel
  • Teach patient or caregiver proper technique for applying gel or topical solution. Wash hands before and after applying the product to the affected area. If the hands are the affected area, do not wash for at least 1 h after application.
  • Caution patient not to apply product to open skin wounds, infected skin, or skin that is scaling.
  • Caution patient to avoid contact with eyes. Advise patient that if product does come into contact with eyes to wash them with large amounts of cool water and contact health care provider if eye irritation occurs.
  • Advise patient to talk with health care provider before using any other topical agents (eg, astringents, cosmetics, medicated soaps) on treated skin.
  • Advise patient that avoiding ultraviolet light is an important part of therapy and to avoid exposure to sunlight or tanning lamps, use sunscreen, and wear protective clothing during treatment.
  • Advise patient to notify health care provider if condition does not improve or if it worsens, or if application-site reactions (eg, dry skin, irritation, rash, redness, scaling) develop and are bothersome.
  • Flector
  • Instruct patient to wash hands after applying, handling, or removing the patch.
  • Caution patients to use patch only on intact skin.
  • Advise patients to avoid contact with eyes or mucosa. If eye contact occurs, instruct patient to immediately wash out the eye with water or saline and contact their health care provider if irritation persists for more than 1 h.
  • Instruct patient that if patch begins to peel off, the edges may be taped down.
  • Instruct patient not to wear patch when bathing or showering.

Copyright © 2009 Wolters Kluwer Health.

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