Diflunisal

Diflunisal Brand Name– Dolobid

What is Diflunisal

Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) that also possesses analgesic properties.

Diflunisal is a difluorophenyl derivative of salicylic acid (i.e., difluorophenylsalicylic acid).

As opposed to other salicylates, diflunisal is not metabolized to salicylic acid and the fluorine atoms are not displaced from the difluorophenyl ring structure. However, diflunisal may interfere with some salicylate assays resulting in falsely elevated salicylate levels.

In animal studies, diflunisal has more potent antiinflammatory activity; however, diflunisal does not have significant antipyretic effects, probably due to poor penetration into the CNS.

All NSAIDs including diflunisal cause an increased risk of serious gastrointestinal adverse effects including bleeding, ulceration, and perforation of the stomach or intestines and may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.

The lowest effective diflunisal dose for the shortest possible duration is recommended, as the risk for adverse effects may increase with duration of use. Diflunisal is indicated for the management of osteoarthritis and rheumatoid arthritis as well as for the relief of mild to moderate pain.

The FDA approved diflunisal in April 1982.

Indications

1. arthralgia
2. bone pain
3. dental pain
4. dysmenorrhea
5. headache
6. migraine
7. mild pain
8. moderate pain
9. myalgia
10. osteoarthritis
11. rheumatoid arthritis

For the treatment of acute or chronic osteoarthritis

Side Effects

1. abdominal pain
2. agranulocytosis
3. anaphylactoid reactions
4. anemia
5. angioedema
6. anorexia
7. aseptic meningitis
8. asthenia
9. blurred vision
10. bronchospasm
11. chest pain (unspecified)
12. cholestasis
13. confusion
14. constipation
15. depression
16. diarrhea
17. dizziness
18. drowsiness
19. dyspepsia
20. dyspnea
21. dysuria
22. edema
23. elevated hepatic enzymes
24. eructation
25. erythema multiforme
26. exfoliative dermatitis
27. fatigue
28. flatulence
29. flushing
30. gastritis
31. GI bleeding
32. GI perforation
33. hallucinations
34. headache
35. hearing loss
36. heart failure
37. hematuria
38. hemolytic anemia
39. hepatic failure
40. hepatic necrosis
41. hepatitis
42. hyperhidrosis
43. hypertension
44. insomnia
45. interstitial nephritis
46. jaundice
47. muscle cramps
48. myocardial infarction
49. nausea
50. necrotizing fasciitis
51. nephrotic syndrome
52. palpitations
53. paresthesias
54. peptic ulcer
55. peripheral edema
56. photosensitivity
57. platelet dysfunction
58. proteinuria
59. pruritus
60. rash
61. renal failure (unspecified)
62. renal papillary necrosis
63. Stevens-Johnson syndrome
64. stomatitis
65. stroke
66. syncope
67. thrombocytopenia
68. thromboembolism
69. tinnitus
70. toxic epidermal necrolysis
71. urticaria
72. vertigo
73. visual impairment
74. vomiting

Monitoring Parameters

• CBC
• LFTs
• serum creatinine/BUN
• stool guaiac

Contraindications

• acute bronchospasm
• acute myocardial infarction
• alcoholism
• anemia
• angina
• anticoagulant therapy
• asthma
• biliary tract disease
• bone marrow suppression
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• coagulopathy
• coronary artery bypass graft surgery (CABG)
• coronary artery disease
• dehydration
• dental disease
• dental work
• diabetes mellitus
• edema
• gastritis
• geriatric
• GI bleeding
• GI disease
• GI perforation
• heart failure
• hemophilia
• hepatic disease
• hyperaldosteronism
• hypertension
• hypovolemia
• immunosuppression
• influenza
• intramuscular injections
• jaundice
• labor
• myocardial infarction
• neutropenia
• NSAID hypersensitivity
• obstetric delivery
• peptic ulcer disease
• peripheral vascular disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• salicylate hypersensitivity
• sepsis
• stroke
• surgery
• systemic lupus erythematosus (SLE)
• tachycardia
• thrombocytopenia
• thromboembolism
• thrombolytic therapy
• tobacco smoking
• ulcerative colitis
• urticaria
• varicella
• viral infection

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