General

Pronunciation
dye-KLOE-fen-ak

Trade Name(s)

• Flector

Pregnancy Category
Category C

Ther. class.
nonsteroidal anti inflammatory agents
analgesics

Indications

Topical treatment of acute pain due to minor strains, sprains, and contusions

Action

Inhibits prostaglandin synthesis

Therapeutic Effect(s):
Decreased pain

Pharmacokinetics

Absorption: Well absorbed following topical application

Distribution: Unknown

Protein Binding: >99%

Metabolism and Excretion: Mostly metabolized by the liver, metabolites are excreted in urine and bile

Half-life: 12 hr

TIME/ACTION PROFILE

ROUTE	ONSET	PEAK	DURATION
Top	unknown	10–20 hr	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity; cross-sensitivity with other NSAIDs may exist

• History of Aspirin Triad (nasal polyps, asthma, bronchospasm following aspirin)

• Treatment of perioperative pain following coronary artery bypass graft (CABG) surgery

• Advanced renal disease

• Application to non-intact or damaged skin

• OB: Late pregnancy (may cause premature closure of the ductus arteriosus) or lactation

Use Cautiously in:

• Geri: Increased risk of adverse effects; consider age-related decrease in metabolic pathways, concurrent disease states and drug therapy

• History of cardiovascular disease or risk factors (increased risk of serious cardiovascular effects)

• History of hypertension or edema (may exacerbate condition)

• History of impaired renal or hepatic function, heart failure, concurrent ACE inhibitor or diuretic therapy (increased risk of renal toxicity)

• Chronic corticosteroid therapy (slow tapering of corticosteroids required)

• Bleeding abnormalities or platelet dysfunction

• Pedi: Safe use not established

Exercise Extreme Caution in:

• History of ulcer disease or GI bleeding

• Pre-existing asthma

Adverse Reactions/Side Effects

CV: edema, hypertension.

GI: GI BLEEDING, liver enzymes.

GU: renal toxicity.

Derm: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, local reactions at treatment site, rash.

Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLATOID REACTIONS.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Concurrent use with aspirin or warfarin may risk of adverse GI reactions

• May antihypertensive response to thiazide diuretics, ACE inhibitors, or loop diuretics

• May blood levels and risk of toxicity from lithium or methotrexate; careful monitoring required

Route/Dosage

• Topical (Adults): 1 patch applied to most painful area twice daily.

Availability

• Topical patch: 180 mg/patch

Assessment

• Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions

• Assess pain and limitation of movement; note type, location, and intensity before and 30–60 min after administration

• Monitor blood pressure closely during initiation of treatment and periodically during therapy in patients with hypertension

Lab Test Considerations

• Diclofenac has minimal effect on bleeding time and platelet aggregation

» Monitor CBC and chemistry profile periodically during therapy. May cause anemia, liver or renal dysfunction

Potential Nursing Diagnoses

• Acute pain (Indications)

Implementation

• To minimize side effects, use the lowest effective dose for the shortest duration possible. Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects

• Topical: Apply patch to the most painful area twice a day. Do not apply to non-intact or damaged skin resulting from any etiology (exudative dermatitis, eczema, infected lesion, burns, wounds). Avoid contact with eyes; wash hands after applying, handling, or removing patch

Patient/Family Teaching

• Instruct patient on correct application procedure for patch. Apply patch to most painful area. Change patch every 12 hr. Remove patch if irritation occurs. Fold used patches so adhesive sticks to itself and discard where children and pets cannot get them. Encourage patient to read the NSAID Medication Guide that accompanies the prescription

» Instruct patients if patch begins to peel off to tape the edges. Do not wear patch during bathing or showering. Bathing should take place between scheduled patch removal and application

» Caution patient to avoid concurrent use of alcohol, aspirin, acetaminophen, other NSAIDs, or other OTC medications without consulting health care professional

» May cause serious side effects: CV (MI or stroke), GI (ulcers, bleeding), skin (exfoliative dermatitis, Stevens—Johnson Syndrome, toxic epidermal necrolysis) and hypersensitivity (anaphylaxis). May occur without warning symptoms. Advise patient to stop medication and notify health care professional immediately if symptoms of CV side effects (chest pain, shortness of breath, weakness, slurring of speech), GI side effects (epigastric pain, dyspepsia, melana, hematemesis), skin side effects (skin rash, blisters, fever, itching) or hypersensitivity reactions (difficulty breathing or swelling of face or throat) occur. Inform patient that risk for heart attack or stroke that can lead to death increases with longer use of NSAID medications and in people who have heart disease and that risk of ulcer increases with concurrent use of corticosteroids and anticoagulants, longer use, smoking, drinking alcohol, older age, and having poor health

» Instruct patient to notify health care professional of medication regimen before treatment or surgery

» Advise patient to notify health care professional promptly if unexplained weight gain, swelling of arms and legs or hands and feet, nausea, fatigue, lethargy, pruritis, yellowing of skin or eyes, itching, stomach pain, vomiting blood, bloody or tarry stools, or flu-like symptoms, occur

» Caution female patient to avoid use of diclofenac in last trimester of pregnancy and to notify health care professional if breastfeeding

• Advise patient to minimize use of concurrent NSAIDs during transdermal therapy

Evaluation/Desired Outcomes

Decrease in severity of mild-to-moderate pain

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