Diflunisal
| (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/DosageMild 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.
InteractionsAntacids: 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 ReactionsCV: 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).
PrecautionsPregnancy: 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 |
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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).
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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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