India · Oral · IM Injection · Topical Gel · Pain · Arthritis · Dysmenorrhoea · Voveran · Diclogesic · Voltaren
✗ CKD / renal impairment
✗ Active GI ulcer / GI bleed
✗ Cardiac failure
✗ Third trimester pregnancy
✗ Dengue fever (haemorrhage risk)
⚠️ Triple whammy: NSAID + ACEi + diuretic
⚠️ Avoid with anticoagulants (GI bleed risk)
| Route / Indication | Dose | Frequency | Max/day | Duration |
|---|---|---|---|---|
| Oral — mild/moderate pain | 50 mg | BD–TDS | 150 mg | 3–5 days acute; ongoing for arthritis |
| Oral — SR formulation | 75 mg SR | Once or twice daily | 150 mg | As directed |
| Oral — SR 100mg | 100 mg SR | Once daily | 150 mg | Chronic arthritis |
| Oral — dysmenorrhoea | 50 mg | TDS (start at onset of pain) | 150 mg | Duration of menstrual pain, max 3 days |
| IM injection | 75 mg | Once daily (max twice daily) | 150 mg | Max 2 days IM — switch to oral after |
| IM — renal colic | 75 mg | Single IM dose (may repeat once after 4–6h) | 150 mg | Acute episode only |
| Topical 1% gel | 2–4 g (1–2 cm strip) | 3–4 times daily | Max 32g/day total body | Max 2 weeks |
Diclofenac sodium is the most widely prescribed NSAID in India, used across surgery, orthopaedics, gynaecology, urology, dentistry, and general practice. It is available as Voveran, Diclogesic, and Dynapar in oral, IM injection, topical, and suppository forms. It inhibits both COX-1 and COX-2, providing anti-inflammatory, analgesic, and antipyretic effects. While effective, diclofenac carries the same class-specific risks as all NSAIDs — gastrointestinal bleeding, nephrotoxicity, and cardiovascular risk — and is one of the most commonly implicated drugs in NSAID-related acute kidney injury and peptic ulcer bleeding in Indian hospitals.
Diclofenac injection (Voveran 75mg/3ml) is an intramuscular (IM) preparation only. It must never be given intravenously. IV diclofenac causes severe hypotension and anaphylaxis and has caused deaths. Despite this, IV administration errors continue to occur in India, particularly in settings where the injection is given by non-medical staff. The injection must be given deep into the upper outer quadrant of the gluteal muscle (not the thigh). IM diclofenac should not be used for more than 2 consecutive days — switch to oral diclofenac thereafter to reduce injection-site complications (haematoma, abscess, sciatic nerve injury).
Diclofenac 75mg IM is the first-line analgesic for renal colic in adults in Indian emergency departments, preferred over opioids in patients without contraindications. NSAIDs reduce renal pelvic pressure and ureteric spasm by inhibiting prostaglandin-mediated smooth muscle contraction. A single IM dose provides excellent pain relief within 20–30 minutes and may be repeated once after 4–6 hours. Ensure the patient is not dehydrated and has no pre-existing renal impairment before use.
Topical diclofenac 1% gel (Voveran Emugel, Dynapar gel) is highly effective for localised musculoskeletal pain (osteoarthritis of the knee, soft tissue injuries, back pain) and has significantly lower systemic absorption than oral diclofenac, reducing GI and renal risks. A Cochrane review found topical diclofenac equivalent to oral NSAIDs for knee OA pain relief. For elderly patients, those with CKD, or those with GI risk — topical diclofenac is a safer first-line option than oral. Apply 2–4g (approximately 1–2 cm ribbon of gel) to the affected area 3–4 times daily.