Pharmacology Book

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Diclofenac Gel

Aka: Diclofenac Gel, Voltaren Emulgel
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  1. Dosing: Diclofenac 1% gel applied to affected joints
    1. Measure gel on a dosing card and massage into affected area
    2. Overall maximum: 32 grams/day over all affected joints
    3. Elbow, hand or wrist: 2 grams applied up to 4 times daily (maximum 8 grams/day/joint)
    4. Knee, ankle or foot: 4 grams applied up to 4 times daily (maximum 16 grams/day/joint)
  2. Precautions
    1. Do not use with other topicals
    2. Do not apply heat to application site
    3. Avoid washing area or showering for at least one hour
  3. Pharmacokinetics
    1. Only 6% systemically absorbed
  4. Adverse effects
    1. Local skin reactions
  5. Efficacy
    1. Canadian study demonstrated equivalent efficacy to oral agent for specific joint pain
  6. Contraindications
    1. Absolute
      1. CABG history
      2. Asthma or Aspirin hypersensitivity
      3. Advanced renal disease
    2. Relative (use with caution in this group)
      1. Known cardiovascular disease
      2. Known Peptic Ulcer Disease (however topical diclofenac did not appear to increase ulcer risk)
      3. Hypertension (however topical diclofenac did not appear to increase Blood Pressure)
      4. Hepatic insufficiency
      5. Advanced Chronic Kidney Disease
      6. Congestive Heart Failure or other edematous condition

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