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Diclofenac Topical Dosage

Applies to the following strength(s): 1% ; 3% ; 1.5% ; 1.3% ; 2%

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Actinic Keratosis

3% Gel:
-Apply an amount sufficient to cover each lesion twice a day and rub in gently
-Duration of therapy: 60 to 90 days; complete healing of lesions may not be evident for up to 30 days following cessation of therapy

Comments:
-Normally, 0.5 g is used on each 5 cm x 5 cm lesion site.
-Lesions that do not respond to therapy should be carefully reevaluated and management reconsidered.
-Sun exposure should be avoided during therapy.

Use: For the topical treatment of actinic keratosis

Usual Adult Dose for Osteoarthritis

1% Gel:
Lower Extremities: Apply 4 g to the affected foot, knee, or ankle 4 times a day and rub in gently; not to exceed 16 g/day to any single joint of the lower extremities

Upper Extremities: Apply 2 g to the affected hand, wrist, or elbow 4 times a day and rub in gently; not to exceed 8 g/day to any single joint of the upper extremities

Maximum dose: 32 g/day over all affected joints

Comments:
-When used on the lower extremities, this drug should be applied to the entire affected foot, knee, or ankle; the entire foot includes the sole, the top of the foot, and the toes.
-When used on the upper extremities, apply to the entire affected hand, wrist, or elbow; the entire hand includes the palm, the back of the hands, and the fingers.
-The accompanying dosing card should be used for application; consult manufacturer product information for instructions.

Use: For the relief of pain associated with osteoarthritis of the joints amenable to topical treatment, such as the knees and those of the hands; this drug has not been evaluated for use on the spine, hip, or shoulder

1.5% Topical Solution: Apply 40 drops to each affected knee 4 times a day

2% Topical Solution: Apply 40 mg (2 pump actuations) to each affected knee 2 times a day

Use: For the relief of signs and symptoms of osteoarthritis of the knee(s)

Usual Adult Dose for Pain

1.3% Topical Patch:
-Apply 1 patch to the most painful area twice a day

Use: For the topical treatment of acute pain due to minor strains, sprains, and contusions

Renal Dose Adjustments

Advanced renal disease: Avoid use unless benefit is expected to outweigh risk of worsening renal function

Liver Dose Adjustments

If liver disease develops or if systemic manifestations such as eosinophilia or rash occur, this drug should be discontinued.

Dose Adjustments

Elderly patients may require lower doses due to increased risk for adverse effects and increased likelihood of concomitant cardiovascular, gastrointestinal, hepatic and/or renal dysfunctions. Systemic diclofenac meets the American Geriatrics Society Beers list criteria as a medication that is potentially inappropriate for use in the elderly.

Precautions

US BOXED WARNINGS: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS:
-Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
-This drug is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
-NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at a greater risk for serious GI events.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:
1% Gel:
-Wash hands after use; if treatment site is the hands, wait at least 1 hour to wash hands.
-Do not apply to open wounds; avoid contact with eyes and mucous membranes
-Do not apply heat and/or occlusive dressings to treated joints; avoid exposure to natural or artificial sunlight
-Avoid concomitant use on treated site with other topical products (e.g., sunscreen, lotions, insect repellant)
-Avoid showering/bathing for at least 1 hour following application; avoid wearing clothing or gloves for at least 10 minutes following application

1.5% and 2% Topical Solutions:
-Apply to clean, dry skin; wash hands after use
-To avoid spillage with the 1.5% solution, 10 drops may first be placed in the hand and rubbed onto the knee until 40 drops have been applied.
-Do not apply heat and/or occlusive dressings to treated joints; avoid exposure to natural or artificial sunlight
-Avoid showering/bathing for at least 30 minutes following application
-Avoid contact with eyes/mucous membranes; do not apply to open wounds
-Area must be dry before coming into contact with others and prior to use of other topical products (e.g., sunscreen, lotion, etc.)

1.3% patch:
-If patch begins to peel off, the edges may be secured with tape or with a mesh netting sleeve that is not occlusive
-Do not apply to non-intact or damaged skin
-Do not wear when bathing/showering
-Wash hands after handling; avoid eye contact
-Assure proper disposal of patch as exposure to a small child or pet may result in serious adverse effects

Storage Requirements:
-Gel (1%): Protect from freezing; store with dosing card.
-Gel (3%): Protect from heat; avoid freezing.

General:
-The lowest effective dose for the shortest duration consistent with individual patient treatment goals should be used.
-There is an increased risk of heart attack, heart failure, and stroke when taking nonsteroidal anti-inflammatory drugs (NSAIDs); these events may occur at any time during treatment and risk increases with long term use, a history of cardiovascular (CV) disease or risk factors for CV disease, and higher doses.
-Avoid concomitant use with other NSAIDs.

Monitoring:
-Cardiovascular: Monitor blood pressure during initiation and throughout the course of therapy.
-Gastrointestinal: Monitor for signs/symptoms of gastrointestinal bleeding.
-Renal function: Monitor renal status, especially in patients with conditions where renal prostaglandins have a supportive role in the maintenance of renal perfusion.
-Monitor blood counts, renal, and hepatic function periodically for patients receiving long-term therapy.

Patient Advice:
-Patients should seek medical advice for signs and symptoms of gastrointestinal events, adverse skin reactions, allergic reactions, hepatotoxicity, or unexplained weight gain or edema.
-Patients should seek medical attention immediately if signs/symptoms of cardiovascular events occur including, shortness of breath, slurred speech, chest pain, or weakness on one side of the body.
-Patients should talk to their health care provider if they are pregnant, planning to become pregnant, or breastfeeding; this drug is not recommended for use during pregnancy or lactation.

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