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(die-FLOO-nih-sal)
Dolobid,  Apo-Diflunisal, Novo-Diflunisal, Nu-Diflunisal
Class: Analgesic/Salicylate

 Action Decreases inflammation and relieves pain by inhibiting prostaglandin synthesis and release.

 Indications Relief of mild to moderate pain, rheumatoid arthritis and osteoarthritis.

 Contraindications Hypersensitivity to NSAIDs or aspirin.

 Route/Dosage

Mild to Moderate Pain

ADULTS: PO 500 to 1000 mg for first dose, then 250 to 500 mg q 8 to 12 hr.

Arthritis

ADULTS: PO 250 to 500 mg bid. Maximum dose: PO 750 mg bid.

 Interactions

Antacids: Decreased plasma concentration of diflunisal. Cyclosporine: Increased nephrotoxic effect of cyclosporine possible. Methotrexate: Life-threatening methotrexate toxicity possible. Warfarin: Prothrombin time may increase; increased risk of bleeding.

 Lab Test Interferences May falsely elevate salicylate serum concentrations.

 Adverse Reactions

CV: Peripheral edema. CNS: Headache; somnolence; insomnia; dizziness. DERM: Rash; erythema multiforme; photosensitivity. EENT: Angioedema; tinnitus. GI: Nausea; dyspepsia; GI pain; diarrhea; GI bleeding. GU: Renal impairment; interstitial nephritis; dysuria. HEMA: Thrombocytopenia; agranulocytosis; hemolytic anemia. HEPA Jaundice. RESP: Bronchospasm. OTHER: Anaphylaxis; hypersensitivity syndrome (eg, fever, chills, rash, liver or kidney dysfunction, leukopenia, thrombocytopenia, eosinophilia, DIC).

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Not recommended for children < 12 yr. May increase risk of Reye’s syndrome; do not use if varicella infection or flu symptoms are suspected. Fluid retention: Use with caution in patients with CHF, hypertension or other conditions associated with fluid retention. History of peptic ulcer: Use carefully and closely monitor for GI bleeding or peptic ulcer; monitor patients with GI disease closely.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Do not crush or allow patient to chew tablets.
  • Administer with milk or food to minimize gastric irritation, give patient generous amounts of water or other fluids to increase gastric emptying.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess pain prior to and after administration of medication.
  • Monitor I&O. Notify physician if signs of renal dysfunction occur (decreased urine output, elevated BUN, elevated creatinine).
  • Include hepatic function in each assessment and notify physician if any signs or symptoms of hepatic dysfunction are noted (fatigue, jaundice, abdominal pain, elevated liver enzymes, dark urine).
OVERDOSAGE: SIGNS & SYMPTOMS
  Drowsiness, vomiting, nausea, diarrhea, hyperventilation, tachycardia, sweating, tinnitus, disorientation, decreased urine output, cardiorespiratory arrest, stupor and coma; may lead to death.

 Patient/Family Education

  • Advise patient to swallow tablets whole and not to chew or crush them.
  • Explain that relief of arthritis may not occur for 1 wk to several wks.
  • Caution patients against taking products with aspirin or acetaminophen concurrently with diflunisal unless directed by physician.
  • Warn patient that this medication can precipitate Reye’s syndrome.
  • Advise patients to avoid exposure to sunlight and to use sunscreens or wear protective clothing to avoid photosensitivity reaction until tolerance is determined.
  • Inform patients that first dose tends to have slower onset of pain relief than other drugs with comparable effects.
  • Instruct patients to report immediately any signs of nephrotoxicity including decreased urine output, weight gain, edema, anorexia, nausea and vomiting.
  • Advise patients with history of GI problems to notify physician if abdominal pain, melena or hematemesis develops during therapy.
  • Advise patient to report degree of pain relief to physician.

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