Friday, July 10, 2015

IM Diclofenac Maximum Duration of Treatment

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:
  1. Nicolau syndrome following intramuscular diclofenac administration: a case report. http://josonline.org/pdf/v14i1p104
  2. http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1415164629909
  3. http://jscr.oxfordjournals.org/content/2013/2/rjs039

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