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Dosage regimen: As a general recommendation, the dose should be individually adjusted. Adverse effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms (see Precautions).
General target population: Adults: Voltaren: Enteric-coated tablet/Suppository: The recommended initial daily dose is 100 to 150 mg. In milder cases, as well as for long-term therapy, 75 to 100 mg daily is usually sufficient.
The total daily dose should generally be divided into 2 to 3 separate doses. To suppress nocturnal pain and morning stiffness, treatment with tablets during the day can be supplemented by the administration of a suppository at bedtime (up to a total maximum daily dose of 150 mg).
In primary dysmenorrhoea, the daily dose should be individually adjusted and is generally 50 to 150 mg. A dose of 50 to 100 mg should be given initially and, if necessary, increased over the course of several menstrual cycles up to a maximum of 200 mg/day. Treatment should be started on appearance of the first symptoms and, depending on the symptomatology, continued for a few days.
Suppository: Treatment of migraine attacks with Voltaren suppositories should be started with a dose of 100 mg at the first signs of an impending attack. Additional suppositories up to 100 mg may be taken on the same day if required. Should the patient require further therapy on the following days, the maximum daily dose should be limited to 150 mg in divided doses.
Voltaren SR: The recommended initial daily dose is 100 to 150 mg, administered as 1 tablet of Voltaren prolonged-released 100 mg or as 2 tablets of Voltaren prolonged-released 75 mg.
In milder cases, as well as for long-term therapy, 75 to 100 mg daily is usually sufficient.
Where the symptoms are most pronounced during the night or in the morning, Voltaren prolonged-release 75 mg and 100 mg should preferably be taken in the evening.
Special populations: Renal impairment: Voltaren/Voltaren SR is contraindicated in patients with renal failure (GFR <15 mL/min/1.73 m2) (see Contraindications).
No specific studies have been carried out in patients with renal impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering Voltaren/Voltaren SR to patients with renal impairment (see Precautions).
Hepatic impairment: Voltaren/Voltaren SR is contraindicated in patients with hepatic failure (see Contraindications).
No specific studies have been carried out in patients with hepatic impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering Voltaren/Voltaren SR to patients with mild to moderate hepatic impairment (see Precautions).
Pediatric patients (below 18 years): Voltaren: Enteric-coated tablet/Suppository: Children aged 1 year or over and adolescents should be given 0.5 to 2 mg/kg body weight daily divided into 2 to 3 separate doses, depending on the severity of the disorder.
For treatment of juvenile rheumatoid arthritis, the dose can be raised up to a maximum of 3 mg/kg daily, given in divided doses.
Suppository: Generally, because of their dosage strength, only the 12.5mg and the 25mg suppositories should be used in children and adolescents.
Voltaren 100 mg suppositories are not suitable for children and adolescents.
Voltaren SR: Because of their dosage strength, Voltaren prolonged-release tablets 75 mg and 100 mg are not suitable for children and adolescents.
Geriatric patients (65 years of age or above): No adjustment of the starting dose is generally required for elderly patients. However, caution is indicated on basic medical grounds, especially for frail elderly patients or those with a low body weight. Although the pharmacokinetics of Voltaren/Voltaren SR are not impaired to any clinically relevant extent in elderly patients, Voltaren/Voltaren SR should be used with particular caution in such patients who generally are more prone to adverse reactions (see Preacutions).
Established cardiovascular disease or significant cardiovascular risk factors: The use of high dose diclofenac (150mg/day) for more than 4 weeks is contraindicated in patients with established cardiovascular disease (congestive heart failure, established ischemic heart disease, peripheral arterial disease) or uncontrolled hypertension. If diclofenac treatment is needed, patients with established cardiovascular disease, uncontrolled hypertension or significant cardiovascular risk factors (e.g., hypertension, hyperlipidaemia, diabetes mellitus and smoking) should be treated only after careful consideration and at doses ≤100 mg daily if the treatment is for more than 4 weeks. As the cardiovascular risks of diclofenac may increase with dose and duration of exposure, diclofenac should always be prescribed at the lowest effective daily dose and for the shortest duration possible (see Cardiovascular effects under Precautions.)
Method of administration: Voltaren enteric-coated tablet/Voltaren SR: The tablets should be swallowed whole with liquid, preferably before meals, and must not be divided or chewed.
Voltaren: Suppository: The suppositories should be inserted well into the rectum. It is recommended to take the suppositories after passing stools.
Not to be taken by mouth, as for rectal use only.
