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In a dermal carcinogenicity study conducted in albino mice, daily topical applications of a diclofenac sodium gel product for two years at concentrations up to 0.035% diclofenac sodium (a 29-fold lower diclofenac sodium concentration than present in diclofenac sodium topical gel) did not increase neoplasm incidence.In a photococarcinogenicity study conducted in hairless mice, topical application of a diclofenac sodium gel product at doses up to 0.035% diclofenac sodium (a 29-fold lower diclofenac sodium concentration than present in diclofenac sodium topical gel) resulted in an earlier median time of onset of tumors.Diclofenac was not mutagenic or clastogenic in a battery of genotoxicity tests that included the bacterial reverse mutation assay, Diclofenac did not affect male or female fertility in rats at doses up to 4 mg/kg/day(approximately 2 times than the maximum human topical dose of diclofenac sodium topical gel based on bioavailability and BSA comparison).Study 1 evaluated the efficacy of diclofenac sodium topical gel for the treatment of osteoarthritis of the knee in a 12-week, randomized, double-blind, multicenter, placebo-controlled, parallel-group trial.

If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g., eosinophilia, rash, etc. If these occur, instruct patients to stop diclofenac sodium topical gel and seek immediate medical therapy [Advise patients to be alert for the symptoms of congestive heart failure including shortness of breath, unexplained weight gain, or edema and to contact their healthcare provider if such symptoms occur [Inform patients of the signs of an anaphylactic reaction (e.g., difficulty breathing, swelling of the face or throat). Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include longer duration of NSAID therapy; concomitant use of oral corticosteroids, aspirin, anticoagulants, or selective serotonin reuptake inhibitors (SSRIs); smoking; use of alcohol; older age; and poor general health status. Diclofenac sodium topical gel has not been evaluated for use on the spine, hip, or shoulder. Advise patients that if eye contact occurs, immediately wash out the eye with water or saline and consult a physician if irritation persists for more than an hour [Instruct patients how to use the dosing card to measure the proper dose of diclofenac sodium topical gel to apply.If the patient loses their dosing card, instruct them that they can callInstruct patients how to correctly measure the 2.25 inches (2 g) dose or 4.5 inches (4 g) dose while waiting for a replacement dosing card [Instruct patients not to apply diclofenac sodium topical gel to open skin wounds, infections, inflammations, or exfoliative dermatitis, as it may affect absorption and tolerability of the drug.Instruct patients to avoid concomitant use of diclofenac sodium topical gel with other topical products, including sunscreens, cosmetics, lotions, moisturizers, and insect repellants. The most common adverse reaction that led to discontinuation of the study was application site dermatitis, which was experienced by 6% of patients.See Table 2 for clinically significant drug interactions with diclofenac.Pregnancy Category C prior to 30 weeks gestation; Category D starting 30 weeks gestation Use of NSAIDs, including diclofenac sodium topical gel, during the third trimester of pregnancy increases the risk of premature closure of the fetal ductus arteriosus. ), diclofenac sodium topical gel should be discontinued immediately.Inform patients of the warning signs and symptoms of hepatotoxicity (e.g., nausea, fatigue, lethargy, diarrhea, pruritus, jaundice, right upper quadrant tenderness, and "flu-like" symptoms).

The pharmacokinetics of diclofenac sodium topical gel has been tested under conditions of moderate heat (application of a heat patch for 15 minutes prior to gel application) and of moderate exercise (first gel application followed by a 20-minute treadmill exercise). This is not a list of all drugs or health problems that interact with diclofenac gel (1%). Gastrointestinal bleeding has occurred.

The potential effects of diclofenac sodium topical gel on skin response to ultraviolet damage in humans are not known.Contact of diclofenac sodium topical gel with eyes and mucosa, although not studied, should be avoided.

Do not apply more than 16 g daily to any single joint of the lower extremities.Apply the gel (2 g) to the affected hand, wrist, or elbow 4 times daily. WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion may not be useful due to high protein binding.For additional information about overdosage treatment, contact a poison control center (1-800-222-1222).Diclofenac sodium topical gel, 1% is a nonsteroidal anti-inflammatory drug (NSAID) for topical use only.

Of these, 355 patients were treated for osteoarthritis of 1 knee and 228 were treated for osteoarthritis of both knees.

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