Diflunisal
DOLOBID
What it isSalicylate-derived COX-1/COX-2 inhibitor; arthritis and mild-to-moderate pain.
Why this oneIts long duration distinguishes it from aspirin without aspirin’s irreversible platelet effect.
What limits itGI bleeding, kidney injury, and cardiovascular events remain; tinnitus can occur, and lithium levels rise.
FDA-approved for
- osteoarthritis, rheumatoid arthritis and mild-to-moderate pain
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Mild to moderate pain | Adults | 1,000 mg once, then 500 mg q12h (some patients 500 mg q8h; lower-dose option 500 mg then 250 mg q8–12h) | 500 mg q12h | 1,500 mg/day |
| Osteoarthritis / rheumatoid arthritis | Adults | 500–1,000 mg/day in two divided doses | 500–1,000 mg/day divided BID | 1,500 mg/day |
Renal Undefined
Hepatic Undefined
Maintenance doses above 1,500 mg/day are not recommended; concentration-dependent kinetics — doubling the dose more than doubles accumulation.
Instructions
- Use the lowest effective dose for the shortest duration consistent with treatment goals
- Swallow tablets whole; do not crush or chew
- Avoid use in pregnancy at about 30 weeks gestation and later
Contraindications
- Coronary artery bypass graft (CABG) surgery setting
- Asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs
Cautions
- Cardiovascular thrombotic events (MI, stroke)
- Serious GI bleeding, ulceration, and perforation (may occur without warning; elderly at greater risk)
- Anaphylactic/anaphylactoid reactions; caution with preexisting asthma
- Fetal toxicity (premature ductus closure; oligohydramnios/neonatal renal impairment)
- Serious skin reactions (exfoliative dermatitis, SJS, TEN, fixed drug eruption)
Adverse reactions
- Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence
- Somnolence, insomnia
- Dizziness
- Tinnitus
- Rash
- Headache, fatigue
Pregnancy Avoid at ≈30 weeks gestation and later (premature ductus arteriosus closure); use at ≈20 weeks or later may cause oligohydramnios/neonatal renal impairment.
Lactation Undefined
⚠ BOXED WARNINGS
- Cardiovascular thrombotic events
- Gastrointestinal bleeding, ulceration and perforation
Cost, est. cash$10–$300/month
Generic entry1992
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.
Mechanism of action: Diflunisal ballicule
Open Diflunisal in the interactive console ↗
Memory aids: mascots and interaction avatars
“The N said... NSAID”
Dosed BID, as the name suggests
