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diclofenac topical (Rx)Brand and Other Names:Flector Transdermal Patch, Voltaren Gel, more...Pennsaid topical solution, Solaraze Gel

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

gel

  • 1% (Voltaren)
  • 3% (Solaraze)

patch

  • 1.3% (180mg) (Flector)

topical solution (Pennsaid)

  • 1.5% (16.05mg/mL; dropper bottle)
  • 2% (20mg/pump actuation)
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Actinic Keratoses

Solaraze gel: Apply thin layer to affected skin q12hr x60-90 days

Osteoarthritis

Voltaren gel

  • Apply 2 g (upper extremities)/4 g (lower extremities) q6hr
  • Not to exceed 8 g/day to any single joint of (upper) extremities; 16 g/day to any single joint of (lower extremities)
  • Administration: Use supplied dosing card to determine amount

Pennsaid topical solution

  • Indicated for osteoarthritis of the knee
  • 1.5%: Apply 40 gtt on each painful knee QID; dispense 10 gtts at a time either directly onto knee or first into hand and then spread evenly to front, sides, and back of knee; repeat procedure until 40 gtt have been applied
  • 2%: Apply 40 mg (2 pump actuations) on each painful knee BID; dispense 40 mg at a time directly into palm of hand and then apply evenly to front, sides, and back of knee

Acute Pain

Flector patch: 1 patch q12hr applied on most painful area

Actinic keratoses

Solaraze gel: Apply to lesion area q12hr for 60-90 days

Administration

Pennsaid 2%: Prime pump before first use by fully depressing the pump mechanism (actuation) 4 times while holding the bottle in an upright position; this portion should be discarded to ensure proper priming

Apply to clean, dry skin

Avoid showering/bathing until gel/solution is dry for at least 30 min

Wash hands after use

Avoid clothing on knees until gel/solution is dry

Safety and efficacy not established

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Interactions

Interaction Checker

diclofenac topical and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dry skin (25-27%)

            Rash (20-35%)

            Contact dermatitis (19-33%)

            Pain (15-26%)

            Paresthesia (≤ 20%)

            Pruritus (≤ 52%)

            Exfoliation (6-24%)

            1-10%

            Hypertension

            Chest pain

            Skin ulcer

            Diarrhea

            Dyspepsia

            Alepesia

            Photosensitivity

            Edema

            Conjunctivitis

            Hematuria

            Asthma

            Pneumonia

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            Warnings

            Black Box Warnings

            Cardiovascular Risk

            • NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), & stroke, which can be fatal
            • Risk may increase with duration of use
            • Patients with risk factors for or existing cardiovascular disease may be at greater risk
            • NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (increased risk of MI & stroke)
            • Transdermal patch is contraindicated for use on non intact or damaged skin

            Gastrointestinal Risk

            • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines, which can be fatal
            • GI adverse events may occur at any time during use & without warning symptoms
            • Elderly patients are at greater risk for serious GI events

            Contraindications

            Hypersensitivity to diclofenac, aspirin other NSAIDs or any ingredient

            CABG perioperative period

            Cautions

            Active GI ulceration or bleeding, severe renal/hepatic impairment, history of aspirin triad, elderly, history of heart failure

            Risks of: cardiovascular thrombotic events; GI bleeding & ulceration; hepatotoxicity (with Na-salt)

            Avoid sun exposure

            Avoid using on open skin wounds, infected lesions, or exfoliative dermatitis

            Concurrency with diuretics or ACE inhibitors

            NSAIDs can lead to new onset or worsening of preexisting hypertension

            Fluid retention and edema observed; monitor patients with conditions that may be aggravated (eg, CHF)

            Avoid contact with eyes

            Do not wear patch while showering

            Elevations of 1 or more liver tests may occur during therapy with Flector Patch

            Note: Not all Cautions/Contraindications apply to Solaraze/Flector

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            Pregnancy & Lactation

            Pregnancy Category: 1st and 2nd trimesters - B (Solaraze), C (Voltaren gel, Pennsaid, Flector Patch); category D during 3rd trimester because of risk for premature closure of the ductus arteriosus

            Lactation: Excretion in milk unknown/not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Decreases formation of prostaglandin by inhibiting cyclooxygenase enzymes 1 and 2; may have anti-inflammatory effects by inhibiting chemotaxis, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels

            Pharmacokinetics

            Half-Life: 12 hr (patch)

            Absorption: 10% in epidermis (Solaraze gel); 6% systemic (Voltaren gel); 2-3% (topical solution)

            Peak Plasma Time: 4.5±8 hr (Solaraze); 10-14 hr (Voltaren gel); 10-20 hr (Flector Patch)

            Excretion: Urine

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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