ASK DIS: IM Diclofenac Maximum Duration of Treatment

Friday, July 10, 2015

IM Diclofenac/ 75mg/3ml

Dosing

One ampoule once (or in severe cases twice) daily intramuscularly by deep intragluteal injection into the upper outer quadrant.
If two injections daily are required it is advised that the alternate buttock be used for the second injection.
Diclofenac injection 75 mg / 3 ml (given i.m. or i.v.) should not be given for more than 2 days; if necessary, treatment can be continued with tablets or suppositories.
Combinations with other dosage forms of Diclofenac (tablets or suppositories) can be used up to the maximum daily dosage of 150mg.

Administration

The solution should be injected slowly and securely intramuscularly after a control aspiration.
A depot into the vicinity of nerves should be avoided.
If more severe pain or malaise occurs during the injection, the procedure should be discontinued.
Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control the symptoms

Rationale for Maximum 2 days:

There are no evidence discussing the selection of maximum duration of therapy.
This most likely is due to the rare side effects of administration of diclofenac via the IM route
Several case report of Nicolau syndrome (livedoid dermatitis) had been reported. It is a rare, adverse reaction involving skin, subcutaneous, and even muscle tissue necrosis at the site of intramuscular drug injection
The phenomenon has been related to the administration of a variety of drugs including NSAIDs
Diclofenac is a cyclooxygenase inhibitor, and it may inhibit prostaglandin synthesis through its vasospasm effect. Subcutaneous injection instead of intramuscular injection was an important contributing factor in the present case

References:

ASK DIS