Data from FDA (Food and Drug Administration, USA) - Curated by EPG Health - Last updated 12 March 2018

Indication(s)

INDICATIONS AND USAGE Diclofenac sodium ophthalmic solution, 0.1% is indicated for the treatment of postoperative inflammation in patients who have undergone cataract extraction and for the temporary relief of pain and photophobia in patients undergoing corneal refractive surgery.

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Advisory information

contraindications
CONTRAINDICATIONS Diclofenac sodium ophthalmic solution, 0.1% is contraindicated in patients who are hypersensitive to any component of the medication.
Special warnings and precautions
PRECAUTIONS General All topical nonsteroidal anti-inflammatory drugs (NSAIDs) may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems. Use of topical NSAIDs may result in keratitis. In some susceptible patients continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal infiltrates, corneal erosion, corneal ulceration, and corneal perforation. These events may be sight-threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs and should be closely monitored for corneal health. Postmarketing experience with topical NSAIDs suggests that patients experiencing complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface disease (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events, which may become sight-threatening. Topical NSAIDs should be used with caution in these patients. Postmarketing experience with topical NSAIDs also suggests that use more than 24 hours prior to surgery or use beyond 14 days postsurgery may increase patient risk for occurrence and severity of corneal adverse events. It is recommended that Diclofenac sodium ophthalmic solution, 0.1%, like other NSAIDs, be used with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. Use of the same bottle for both eyes is not recommended with topical eye drops that are used in association with surgery. Results from clinical studies indicate that Diclofenac sodium ophthalmic solution, 0.1% has no significant effect upon ocular pressure. However, elevations in intraocular pressure may occur following cataract surgery. Information for Patients Except for the use of a bandage hydrogel soft contact lens during the first 3 days following refractive surgery, Diclofenac sodium ophthalmic solution, 0.1% should not be used by patients currently wearing soft contact lenses due to adverse events that have occurred in other circumstances. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term carcinogenicity studies in rats given Diclofenac sodium ophthalmic solution, 0.1% in oral doses up to 2mg/kg/day (approximately 500 times the human topical ophthalmic dose) revealed no significant increases in tumor incidence. A 2-year carcinogenicity study conducted in mice employing oral Diclofenac sodium ophthalmic solution, 0.1% up to 2 mg/kg/day did not reveal any oncogenic potential. Diclofenac sodium ophthalmic solution, 0.1% did not show mutagenic potential in various mutagenicity studies including the Ames test. Diclofenac sodium ophthalmic solution, 0.1% administered to male and female rats at 4 mg/kg/day (approximately 1000 times the human topical ophthalmic dose) did not affect fertility. Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and younger adult patients. PREGNANCY Teratogenic Effects Pregnancy Category C. Reproduction studies performed in mice at oral doses up to 5,000 times (20 mg/kg/day) and in rats and rabbits at oral doses up to 2,500 times (10 mg/kg/day) the human topical dose have revealed no evidence of teratogenicity due to Diclofenac sodium ophthalmic solution, 0.1% despite the induction of maternal toxicity and fetal toxicity. In rats, maternally toxic doses were associated with dystocia, prolonged gestation, reduced fetal weights and growth, and reduced fetal survival. Diclofenac sodium ophthalmic solution, 0.1% has been shown to cross the placental barrier in mice and rats. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Non-teratogenic Effects Because of the known effects of prostaglandin biosynthesis inhibiting drugs on the fetal cardiovascular system (closure of ductus arteriosus), the use of Diclofenac sodium ophthalmic solution, 0.1% during late pregnancy should be avoided. Nursing Women It is not known whether topical ophthalmic administration of Diclofenac sodium ophthalmic solution, 0.1% could result in sufficient systemic absorption to produce detectable quantities in breast milk. Because many drugs are excreted in human milk, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use Safety and effectiveness in pediatric patients have not been established.
Adverse reactions
ADVERSE REACTIONS Ocular Transient burning and stinging were reported in approximately 15% of patients across studies with the use of Diclofenac sodium ophthalmic solution, 0.1%. In cataract surgery studies, keratitis was reported in up to 28% of patients using Diclofenac sodium ophthalmic solution, 0.1%, although in many of these cases keratitis was initially noted prior to the initiation of treatment. Elevated intraocular pressure following cataract surgery was reported in approximately 15% of patients undergoing cataract surgery. Lacrimation complaints were reported in approximately 30% of case studies undergoing incisional refractive surgery. The following adverse reactions were reported in approximately 10% or less of the patients: abnormal vision, acute elevated IOP, blurred vision, conjunctivitis, corneal deposits, corneal edema, corneal opacity, corneal lesions, discharge, eyelid swelling, eye pain, injection (redness), iritis, irritation, itching, lacrimation disorder, and ocular allergy. Systemic The following adverse reactions were reported in 3% or less of the patients: abdominal pain, asthenia, chills, dizziness, facial edema, fever, headache, insomnia, nausea, pain, rhinitis, viral infection and vomiting. Clinical Practice The following reactions have been identified during postmarketing use of topical diclofenac sodium ophthalmic solution, 0.1% in clinical practice. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. The reactions, which have been chosen for inclusion due to either their seriousness, frequency of reporting, possible causal connection to topical diclofenac sodium ophthalmic solution, 0.1%, or a combination of these factors, include corneal erosion, corneal infiltrates, corneal perforation, corneal thinning, corneal ulceration and epithelilal breakdown (see PRECAUTIONS, General). TO REPORT SUSPECTED ADVERSE REACTIONS, contact Altaire Pharmaceuticals, Inc., at 1-800-258-2471 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Usage information

Dosing and administration
DOSAGE AND ADMINISTRATION Cataract Surgery One drop of Diclofenac sodium ophthalmic solution, 0.1% should be applied to the affected eye, 4 times daily beginning 24 hours after cataract surgery and continuing through the first 2 weeks of the postoperative period. Corneal Refractive Surgery One or two drops of Diclofenac sodium ophthalmic solution, 0.1% should be applied to the operative eye within the hour prior to corneal refractive surgery. Within 15 minutes after surgery, one or two drops should be applied to the operative eye and continued 4 times daily for up to 3 days.
Pregnancy and lactation
Nursing Women It is not known whether topical ophthalmic administration of Diclofenac sodium ophthalmic solution, 0.1% could result in sufficient systemic absorption to produce detectable quantities in breast milk. Because many drugs are excreted in human milk, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

More information

Category Value
Authorisation number ANDA203383
Agency product number QTG126297Q
Orphan designation No
Product NDC 59390-149
Date Last Revised 25-01-2018
Type HUMAN PRESCRIPTION DRUG
RXCUI 854801
Marketing authorisation holder Altaire Pharmaceuticals Inc.