Diclofenac Sodium (diclofenac sodium)

No dosing information is available for this tab.

No dosing information is available for this tab.

The manufacturer states that specific drug interaction studies between diclofenac sodium 3% gel and other topical or oral agents have not been performed.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

Known hypersensitivity to diclofenac or any ingredient in the formulation.

In the setting of coronary artery bypass graft (CABG) surgery.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

• Corneal degeneration
• Corneal erosion
• Corneal ulcer
• Diabetes mellitus
• Increased risk of bleeding due to coagulation disorder
• Infiltrate of cornea
• Keratitis
• Perforation of cornea
• Rheumatoid arthritis

There is no enhanced messaging for this drug.

More Frequent

• Ocular hypertension

Less Frequent

• Conjunctivitis

Rare or Very Rare

• Corneal deposits
• Corneal edema
• Corneal epithelial degeneration
• Corneal erosion
• Corneal opacity
• Corneal ulcer
• Facial edema
• Infiltrate of cornea
• Ocular hemorrhage
• Punctate keratitis

More Frequent

• Ocular irritation

Less Frequent

• Anterior chamber inflammation
• Blurred vision
• Ocular pain
• Visual changes

Rare or Very Rare

• Dizziness
• Fever
• Headache disorder
• Impaired wound healing
• Keratitis
• Nausea
• Rhinitis
• Vomiting

No enhanced messaging available.

Safety and efficacy not established in children. Actinic keratoses generally are not seen in the pediatric population; diclofenac sodium 3% gel should not be used by children.

Safety of diclofenac sodium 3% gel has not been established during pregnancy.

Use of NSAIAs during pregnancy at about 30 weeks of gestation or later can cause premature closure of the fetal ductus arteriosus, and use at about 20 weeks of gestation or later has been associated with fetal renal dysfunction resulting in oligohydramnios and, in some cases, neonatal renal impairment. Because of these risks, use of NSAIAs should be avoided in pregnant women at about 30 weeks of gestation or later; if NSAIA therapy is necessary between about 20 and 30 weeks of gestation, the lowest effective dosage and shortest possible duration of treatment should be used. Monitoring of amniotic fluid volume via ultrasound examination should be considered if the duration of NSAIA treatment exceeds 48 hours; if oligohydramnios occurs, the drug should be discontinued and follow-up instituted according to clinical practice. (See Advice to Patients.)

Known effects of NSAIAs on the human fetus during the third trimester of pregnancy include prenatal constriction of the ductus arteriosus, tricuspid incompetence, and pulmonary hypertension; nonclosure of the ductus arteriosus during the postnatal period (which may be resistant to medical management); and myocardial degenerative changes, platelet dysfunction with resultant bleeding, intracranial bleeding, renal dysfunction or renal failure, renal injury or dysgenesis potentially resulting in prolonged or permanent renal failure, oligohydramnios, GI bleeding or perforation, and increased risk of necrotizing enterocolitis.

Fetal renal dysfunction resulting in oligohydramnios and, in some cases, neonatal renal impairment has been observed, on average, following days to weeks of maternal NSAIA use, although oligohydramnios has been observed infrequently as early as 48 hours after initiation of NSAIA therapy. Oligohydramnios is often, but not always, reversible (generally within 3-6 days) following discontinuance of NSAIA therapy. Complications of prolonged oligohydramnios may include limb contracture and delayed lung maturation. A limited number of case reports have described maternal NSAIA use and neonatal renal dysfunction, in some cases irreversible, without oligohydramnios. Some cases of neonatal renal dysfunction have required treatment with invasive procedures such as exchange transfusion or dialysis. Deaths associated with neonatal renal failure have been reported. Methodologic limitations of these postmarketing studies and case reports include lack of a control group; limited information regarding dosage, duration, and timing of drug exposure; and concomitant use of other drugs. These limitations preclude establishing a reliable estimate of the risk of adverse fetal and neonatal outcomes with maternal NSAIA use. Available data on neonatal outcomes generally involved preterm infants, and the extent to which certain reported risks can be generalized to full-term infants is uncertain.

Animal data indicate that prostaglandins have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization. In animal studies, inhibitors of prostaglandin synthesis, such as diclofenac, were associated with increased pre- and post-implantation losses. Prostaglandins also have an important role in fetal kidney development. In animal studies, inhibitors of prostaglandin synthesis impaired kidney development at clinically relevant doses.

No evidence of teratogenicity was observed in reproduction studies in mice, rats, or rabbits at diclofenac doses at least 15 times the maximum recommended human dose of diclofenac sodium 3% gel. In rats, maternally toxic doses of diclofenac were associated with dystocia, prolonged gestation, reduced fetal weight and growth, and reduced fetal survival.

The effects of diclofenac on labor and delivery in pregnant women are unknown.

Discontinue nursing or the drug because of potential risk in nursing infants.

Individuals 65 years of age or older were included in clinical trials since actinic keratoses occur frequently in an older patient population. No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.