藥劑部參考美國 Johns Hopkins 大學研究團隊所建立的 NxP (Nephrotoxic Potential) 專家共識分級清單，本品具「顯著以上腎毒性風險」，被認定具中度至高度腎損傷潛勢，特別是同時合併其他腎毒性藥物、脫水、高齡或既有腎功能異常的患者族群，應更加注意。

【缺藥訊息】 公告日期：2024/2/7。 缺藥品項：Voren 大 針 75 mg/3 mL/Amp。 缺藥原因：因製造問題缺藥。 替代藥品：院內有同類品 。 配套措施：藥品用罄關檔停用，建請改以院內退燒藥品，如 Acetamol 針替代。 【藥品性質提示】 GFR <30 mL/min 以下之慢性腎臟疾病病人，建議勿處方本品 (NSAID)。

Ankylosing spondylitis.
Osteoarthritis.
Pain, acute, Mild to moderate.
Pain, acute, Moderate to severe; with or without opioids.
Rheumatoid arthritis.

Distribution: Protein binding: Greater than 99%, Vd, IV: 40.1 to 83.4 L.
Metabolism: Liver: Extensive via CYP2C9.
Excretion: Biliary: 35% as conjugates and metabolites, Renal: 65%; Total body clearance, IV: 282 to 387 mL/min.
Elimination Half Life: IV: 1.4 to 2.29 hours.

Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs, history; severe and rarely fatal anaphylactic-like reactions have been reported.
CABG surgery, treatment of perioperative pain.
Hypersensitivity to diclofenac or any component of the product.
Mild or severe renal insufficiency and at risk for volume depletion during perioperative period.

C (FDA)

Infant risk cannot be ruled out.

Common:
Hematologic: Blood coagulation disorder.
Serious:
Cardiovascular: Cardiac arrest, Congestive heart failure, Hypertension, Myocardial infarction, Thrombotic tendency observations.
Dermatologic: Erythema multiforme, Generalized exfoliative dermatitis, Stevens-Johnson syndrome, Toxic epidermal necrolysis.
Endocrine metabolic: Hyperkalemia.
Gastrointestinal: Gastrointestinal hemorrhage, Gastrointestinal perforation, Gastrointestinal ulcer, Inflammatory disorder of digestive tract, Melena, Pancreatitis.
Hematologic: Agranulocytosis, Aplastic anemia, Hemolytic anemia, Hemorrhage.
Hepatic: Fulminant hepatitis, Hepatic necrosis, Jaundice, Liver failure.
Immunologic: Anaphylactoid reaction, Anaphylaxis, Sepsis.
Neurologic: Cerebrovascular accident, Seizure.
Renal: Acute renal failure, Injury of kidney, Papillary necrosis.
Respiratory: Asthma.
Other: Angioedema.

Pain, acute, Mild to moderate: 37.5 mg slow IV bolus injection over 15 seconds every 6 hours as needed; MAX dose 150 mg/24 hours.
Pain, acute, Moderate to severe; with or without opioids: 37.5 mg slow IV bolus injection over 15 seconds every 6 hours as needed; MAX dose 150 mg/24 hours.

Safety and efficacy have not been established in pediatric patients

moderate to severe: IV formulation not recommended.

Dosage adjustments not necessary.