Diclofenac

Diclofenac - NSAID with analgesic, anti-inflammatory and antipyretic properties. It has an opioid sparing effect. In the critically ill, the side-effects of NSAID are such that they have to be used with extreme caution especially where there is a risk of stress ulceration, and renal impairment and bleeding diatheses are common. Ensure patient is adequately hydrated.

UsesPain, especially musculoskeletal
Antipyretic (unlicensed)

Contraindications:
Uncontrolled asthma
Hypersensitivity to aspirin and other NSAID (cross-sensitivity)
Active peptic ulceration (bleeding)
Haemophilia and other clotting disorders (bleeding)
Renal and hepatic impairment (worsens)
Hypovolaemia
Anticoagulants including low-dose heparin (bleeding) with IV diclofenac

Administration:
• Pain
  PO/NG: 50 mg 8 hourly
  PR: 100 mg suppository 18 hourly
  IV infusion: 75 mg diluted with 100–500 ml sodium chloride 0.9% orglucose 5%. For Voltarol: buffer the solution with sodium       bicarbonate
  (0.5 ml 8.4% or 1 ml 4.2%)
  Give over 30–120 min
  Once prepared use immediately
  There is now a preparation of diclofenac called Dyloject which does not need diluting or buffering, and    can be given as an IV bolus over 3–5 min
Maximum daily dose: 150mg

• Antipyretic
  IV bolus: 10 mg diluted with 20 ml sodium chloride 0.9%, given over 3 min

How not to use diclofenac
Do not give suppository in inflammatory bowel disease affecting anus, rectum and sigmoid colon (worsening of disease)

Adverse effects
Epigastric pain
Peptic ulcer
Rashes
Worsening of liver function tests

Prolonged bleeding time (platelet dysfunction) Acute renal failure – in patients with:
• pre-existing renal and hepatic impairment
• hypovolaemia
• renal hypoperfusion
• sepsis

Cautions
Elderly
Hypovolaemia
Renal and hepatic impairment
Previous peptic ulceration

Organ failure
Hepatic:worsens
Renal:worsens