Guidelines for Administering Diclofenac via Intravenous (IV) Injection

Administration Technique

Ensure proper patient identification and appropriate vascular access before administration, and have emergency medications and equipment readily available before administering IV diclofenac, while monitoring vital signs 1
Monitor for signs of hypersensitivity including rash, urticaria, hypotension, and bronchospasm during administration 1
For newer HPβCD formulations, administer as a small volume bolus over 2-3 minutes while monitoring vital signs 1

Avoid using diclofenac after gestational week 28 in pregnant patients due to risks of oligohydramnios or narrowing/occlusion of the fetal ductus arteriosus, as recommended by the American College of Obstetricians and Gynecologists 2
Do not use IV diclofenac in combination with cryosurgery for actinic keratosis treatment, as evidence suggests no additional benefit, according to the American Academy of Dermatology 3

Topical diclofenac may be considered as an alternative for localized pain, particularly for knee osteoarthritis, as suggested by the Mayo Clinic 4, 5
For patients with chronic non-bacterial osteitis, diclofenac can be administered at 150 mg/day in divided doses initially, with maintenance doses of 75-100 mg/day, according to the European League Against Rheumatism 6

Avoid rapid bolus administration of traditional diclofenac formulations that require dilution, and do not administer through peripheral IV lines with questionable placement due to risk of extravasation, as warned by the American Society of Health-System Pharmacists 1
Be aware that diclofenac, like other NSAIDs, may interfere with ovulation in women trying to conceive, as noted by the American College of Rheumatology 2