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.

Last review date: July 17, 2018