IM Dicofenac : can it be given as IV?

Availability

• Injection Diclofenac Injection 75mg/3ml (Dicloran)

Route of administration

• Based on product information, mode of administration specified is Intramuscular
• No information on administration via other routes

Administration via Intravenous Route

• There are several products available that can be given as IV
• However these products are specifically made for such routes / should not be interchanged
• Complications of wrong administration
• Not much information on effect and management of IM injection administered as IV
• Based on several case reports of administration intravenously into arterial route, symptoms seen are gangrene and burning sensations.
• Vasospasm, intravascular thrombosis, chemical endoarteritis are the proposed pathophysiological mechanism
• Intravenous drug administration has been associated with the occurrence of Thrombophlebitis
• Rare adverse events (based on IV diclofenac): cannula site reaction, infusion site discomfort or burning, injection site stinging, or pyrexia

Contraindications for IV Route

• Concomitant NSAID or anticoagulant use (including low dose heparin).
• History of haemorrhagic diathesis, a history of confirmed or suspected cerebrovascular bleeding.
• Operations associated with a high risk of haemorrhage.
• A history of asthma.
• Moderate or severe renal impairment (serum creatinine >160μmol/l).
• Hypovolaemia or dehydration from any cause

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/25738031
2. https://www.medicines.org.uk/emc/medicine/1339
3. http://www.apicareonline.com/letters-to-editor-accidental-intra-arterial-injection-of-diclofenac-sodium-and-their-consequences-report-of-two-cases/