Drug Guide
Diclofenac Epolamine
Classification
Therapeutic: NSAID (Nonsteroidal Anti-inflammatory Drug)
Pharmacological: Propionic acid derivative
FDA Approved Indications
- Relief of acute pain associated with minor strains, sprains, and bruises
Mechanism of Action
Inhibits cyclooxygenase (COX-1 and COX-2), leading to decreased synthesis of prostaglandins involved in inflammation, pain, and fever
Dosage and Administration
Adult: Use one patch applied to the most painful area twice daily; max duration typically 2 weeks
Pediatric: Not approved for pediatric use
Geriatric: No specific dose adjustments; careful monitoring recommended
Renal Impairment: Use with caution, as NSAIDs can affect renal function
Hepatic Impairment: Use cautiously; dose adjustments may be necessary based on liver function
Pharmacokinetics
Absorption: Absorbed transdermally; peak plasma levels occur within 12 hours
Distribution: Wide distribution; binds extensively to plasma proteins
Metabolism: Metabolized in the liver primarily via glucuronidation
Excretion: Excreted mainly in urine as metabolites
Half Life: Approximately 1-2 hours; prolonged locally due to transdermal delivery
Contraindications
- Hypersensitivity to diclofenac or other NSAIDs
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Active gastrointestinal bleeding or peptic ulcer disease
Precautions
- Use cautiously in patients with cardiovascular, hepatic, or renal impairment
- Avoid in third trimester pregnancy
- Monitor for signs of skin reaction or irritation at application site
Adverse Reactions - Common
- Skin irritation or dermatitis at application site (Common)
Adverse Reactions - Serious
- Stevens-Johnson syndrome, toxic epidermal necrolysis (Rare)
- Gastrointestinal bleeding, ulceration (Rare)
- Cardiovascular thrombotic events (Rare)
Drug-Drug Interactions
- Other NSAIDs or anticoagulants increasing bleeding risk
- ACE inhibitors and diuretics may reduce renal function
Drug-Food Interactions
- Alcohol may increase gastrointestinal bleeding risk
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for skin reactions, pain relief, signs of bleeding, and gastrointestinal discomfort
Diagnoses:
- Risk for bleeding related to NSAID use
- Impaired skin integrity at application site
Implementation: Apply patches as prescribed; avoid touching adhesive side; rotate sites if used long-term
Evaluation: Assess pain relief, monitor for adverse reactions
Patient/Family Teaching
- Apply patch to clean, dry, intact skin; avoid broken or irritated skin
- Do not exceed recommended dose or duration of therapy
- Watch for signs of skin rash, irritation, or systemic side effects
- Avoid other NSAIDs during therapy to minimize risk of adverse effects
Special Considerations
Black Box Warnings:
- Cardiovascular and gastrointestinal risks associated with NSAID use
Genetic Factors: Low potential impact
Lab Test Interference: May slightly increase liver function tests
Overdose Management
Signs/Symptoms: Nausea, vomiting, gastrointestinal bleeding, dizziness
Treatment: Supportive care; activated charcoal if ingestion is recent; symptomatic treatment; no specific antidote
Storage and Handling
Storage: Store at room temperature away from moisture and heat
Stability: Stable through labeled expiration date when stored properly