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INTRODUCTION

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diclofenac (dye-kloe-fen-ak)

diclofenac potassium

Cataflam, Apo-Diclo Rapide diclofenac sodium

Image not available.Apo-Diclo, Voltaren diclofenac topical Solarazediclofenac (topical patch) Flector

Classification

Therapeutic: nonopioid analgesics, nonsteroidal anti-inflammatory agents

Pharmacologic: phenylacetic acid derivative

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Indications
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PO: Management of inflammatory disorders, including Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis. Primary dysmenorrhea. Relief of mild-to-moderate pain. Topical: Treatment of actinic keratoses. Topical patch: treatment of acute pain due to minor strains, sprains, and contusions.

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Action
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Inhibits prostaglandin synthesis. Therapeutic Effects: Suppression of pain and inflammation. Topical: Clearance of actinic keratosis lesions.

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Adverse Reactions/Side Effects
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For oral diclofenac unless noted CNS: dizziness, headache. CV: hypertension. EENT: tinnitus. GI: GI BLEEDING, Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, heartburn, liver enzyme elevation, nausea, vomiting. GU: acute renal failure, hematuria. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, pruritus, rashes, eczema, photosensitivity. F and E: edema. Hemat: anemia, prolonged bleeding time. Local: Topical only: contact dermatitis, dry skin, exfoliation. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for exfoliation, dermatitis, and other severe skin reactions that might indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). Notify physician immediately if these reactions occur.

  • Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decrease impairments.

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). NSAIDs can increase BP and promote hypertension in certain patients.

  • Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of kidney dysfunction such as painful urination or blood in the urine. Report signs of renal failure immediately, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma.

  • Monitor unusual weakness, fatigue, and pallor that might be due to anemia. Notify physician if these signs occur.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • If applied topically, monitor the application site for skin reactions such as dermatitis, ...

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