Dolobid

Do·lo·bid (dl-bd)

A trademark for the drug diflunisal.

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Dolobid,

trademark for a nonsteroidal antiinflammatory agent (diflunisal).

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diflunisal

Dolobid

Pharmacologic class: Nonsteroidal anti-inflammatory drug

Therapeutic class: Nonopioid analgesic, anti-inflammatory

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.
• Contraindicated for treatment of perioperative pain in setting of coronary artery bypass surgery.
• Drug may increase risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation. Elderly patients are at greater risk.

Action

Unclear. Thought to act by inhibiting prostaglandin synthesis.

Availability

Tablets: 250 mg, 500 mg

⊘Indications and dosages

➣ Osteoarthritis; rheumatoid arthritis

Adults: 500 to 1,000 mg P.O. daily in two divided doses, usually given q 12 hours, to a maximum of 1,500 mg/day

➣ Mild to moderate pain

Adults: 1 g P.O., followed by 500 mg q 8 to 12 hours; or 500 mg P.O., followed by 250 mg q 8 to 12 hours (depending on severity of pain and patient's age, weight, and response)

Dosage adjustment

• Renal impairment
• Elderly patients

Contraindications

• Hypersensitivity to drug
• Acute asthmatic attacks
• Bleeding disorders
• Vitamin K deficiency
• Children younger than age 12

Precautions

Use cautiously in:
• renal impairment, compromised cardiac function, hypertension, peptic ulcer
• elderly patients.

Administration

• Give tablets whole with food or milk.

Route	Onset	Peak	Duration
P.O.	1 hr	2-3 hr	8-12 hr

Adverse reactions

CNS: dizziness, insomnia, drowsiness, headache, fatigue

CV: hypertension, myocardial infarction, stroke

EENT: tinnitus

GI: dyspepsia, nausea, vomiting, diarrhea, constipation, flatulence, stomatitis, GI ulcers, GI bleeding, GI perforation

GU: hematuria, renal impairment, interstitial nephritis

Skin: rash, pruritus, sweating, erythema multiforme

Other: Stevens-Johnson syndrome

Interactions

Drug-drug. Acetaminophen, hydrochlorothiazide, indomethacin: increased levels of these drugs

Antacids, aspirin: decreased diflunisal blood level

Anticoagulants, thrombolytics: enhanced anticoagulant effect

Cyclosporine: increased risk of nephrotoxicity

Methotrexate: increased risk of methotrexate toxicity

Patient monitoring

• Monitor fluid intake and output for signs of renal impairment. Assess for dysuria and hematuria.
☞ Watch for signs and symptoms of erythema multiforme (sore throat, fever, rash, cough, iris lesions, mouth sores). Report early signs before condition can progress to Stevens-Johnson syndrome.
• Assess nutritional and hydration status.
• Monitor neurologic status.

Patient teaching

• Instruct patient to swallow tablets whole with food or milk.
• If patient needs antacids, advise him not to take them within 2 hours of diflunisal.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, balance, hearing, and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and ensuring adequate fluid intake.
☞ Tell patient to promptly report rash and other signs and symptoms of erythema multiforme.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.