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diclofenac

diclofenac
  • Restricted Medications Non-Formulary
Brand names: Cambia, Voltaren, Voltaren-XR
No brands, forms, or strengths have been added for this generic.
Display Other Nonsteroidal Anti-inflammatory Agents Class: 28080492
Medication comments:
Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent Formulary Equivalent
diclofenac (Voltaren) 25 mg, 50 mg naproxen (Naprosyn) 375 mg BID
diclofenac (Voltaren) 75 mg naproxen (Naprosyn) 500 mg BID
diclofenac (Voltaren XR) 100 mg naproxen (Naprosyn) 500 mg BID
Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand) Dept. Procedure Type
(hover over entry for examples)		 Stop Medication Prior To Procedure Restart after:
diclofenac
(Voltaren)
(not stocked at IHS)		 Anesthesia High-risk 24 hours Restart after 24 hours
Intermediate-risk No hold Restart after 24 hours
Low-risk No hold Restart after 24 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
Radiology
 Invasive Procedures 24 hours
Paracentesis/Thoracentesis No hold
Surgery High-risk 7 days Restart after 24 hours
Low-risk No Hold Restart after 24 hours
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
diclofenac
(Voltaren)		 Do NOT crush modified-release capsules or tablets If no therapeutic alternative, consider holding tube feeding for 30 minutes prior to administration if used for acute effect.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: diclofenac (Cambia, Cataflam, Voltaren)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s) non-COX-2-selective NSAIDs, oral
Rationale Increased risk of GI bleeding or peptic ulcer disease in high-risk groups, including those >75 years old or taking oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents; use of proton-pump inhibitor or miSOPROStol reduces but does not eliminate risk. Upper GI ulcers, gross bleeding or perforation caused by NSAIDs occur in ~1% of patients treated for 3-6 months and in ~2%-4% of patients treated for 1 year; these trends continue with longer duration of use. Also can increase blood pressure and induce kidney injury. Risks are dose-related.
Recommendation Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent (proton-pump inhibitor or miSOPROStol).
Avoid short-term scheduled use in combination with oral or parenteral corticosteroids, anticoagulants or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent (proton-pump inhibitor or miSOPROStol).
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome NSAIDs and COX-2 inhibitors ⇄ Heart failure
Rationale Potential to promote fluid retention and/or exacerbate heart failure.
Recommendation Use with caution in patients with heart failure who are asymptomatic; avoid in patients with symptomatic heart failure.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome non-COX-2 selective NSAIDs ⇄ History of gastric or duodenal ulcers
Rationale May exacerbate existing ulcers or cause new/additional ulcers
Recommendation Avoid unless other alternatives are not effective and the patient can take a gastroprotective agent (i.e., proton-pump inhibitor or miSOPROStol).
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required <30
Rationale NSAIDs (oral and parenteral) may increase the risk of acute kidney injury and a further decline in kidney function.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Last updated: Nov. 3, 2025
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