ZIPSOR (diclofenac)

ZIPSOR (diclofenac)

SELF ADMINISTRATION - Oral

Indications for Prior Authorization:

• Indicated for relief of mild to moderate acute pain in adults (18 years of age or older)

Patients must meet the following criteria for the indication(s) above:

• Used for the relief of mild to moderate acute pain, AND
• Patient is 18 years of age or older, AND
• Chart note documentation is provided and confirms: patient has tried and failed two preferred generic prescription strength oral NSAIDs (nonsteroidal antiinflammatory drugs), one of the two must be generic Diclofenac tablets OR there is a medically appropriate reason why generic alternatives cannot be tried

Dosing:

• 25 mg four times a day
• Patients with hepatic disease may require reduced doses of Zipsor® compared to patients with normal hepatic function.