NSAID (non-selective COX inhibitor)

Diclofenac sodium

Brand names: Voltarol, Diclomax, Voltarol Emulgel

Adult dose

Dose: 50mg TDS PO; 75mg IM/IV TDS; gel: apply BD–QDS

Route: Oral / IM / IV / Topical / PR

Frequency: BD–TDS

Clinical pearls

MHRA Drug Safety Update 2013/2015: contraindicated in established CV disease
NICE NG100 acute pain / NICE CKS NSAIDs: lowest dose, shortest duration
Topical preparations have negligible systemic absorption — first-line for localised musculoskeletal pain

Contraindications

Established CV disease (IHD, PAD, HF, cerebrovascular disease) — MHRA
Active GI bleeding/ulceration
Severe renal/hepatic impairment
Last trimester pregnancy
NSAID hypersensitivity

Side effects

GI bleeding/ulceration
CV events (MI, stroke) — increased class risk
Renal impairment
Hypertension
Bronchospasm in aspirin-sensitive asthma
Hypersensitivity reactions

Interactions

Anticoagulants/antiplatelets
ACEi/ARB + diuretic ("triple whammy" AKI)
Lithium
Methotrexate
Other NSAIDs

Monitoring

BP
Renal function
FBC
GI symptoms
CV risk review

Reference: BNF; NICE NG100; NICE CKS NSAIDs; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/diclofenac-sodium/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Naproxen · NSAID (Non-selective COX Inhibitor)

Pathways