Common brand names: Dolobid


Description: Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) that relieves pain, reduces fever and lessens swelling and other symptoms of arthritis.


Dental uses: In dentistry, diflunisal is employed to treat pain from dental surgery, toothache and the temporomandibular joint. It is a popular drug among periodontists because of its very long duration of action, up to 12 hours. However, it is slow to take effect. To get around this problem, dentists usually double the first dose.


Dosages for dental purposes: The typical prescription is a first dose of 1,000 milligrams (two Dolobids) followed by 500 milligrams every 12 hours for pain, as needed. The maximum daily dose should not exceed 1,500 milligrams on day one and 1,000 milligrams on all subsequent days. In more severe types of dental pain such as oral surgery, 1,000 milligrams of diflunisal is superior to 650 milligrams of aspirin or acetaminophen and has at least equivalent analgesic effects to 600 mg of acetaminophen plus 60 milligrams of codeine (that is, two Tylenol #3s) or 650 milligrams acetaminophen plus 100 milligrams propoxyphene (that is, one Darvocet N-100). Diflunisal currently is not recommended for use in children. The duration of therapy for post-surgical pain varies but is usually less than five days.


Concerns and possible side effects: With short-term use (less than one week), the most common side effects include abdominal pain, nausea and increased bleeding time, with incidences about equal to those of aspirin. Diflunisal also occasionally causes a dry mouth (xerostomia). With chronic dosing (many weeks or months), as employed in the treatment of arthritis, more serious side effects can occur, often requiring hospitalization. These may include bleeding ulcers and perforations of the stomach and small intestines (seen in 1 percent to 4 percent of patients) and impairment of kidney function. Still, under the typical dental-usage scenario of a few days at most, diflunisal is generally a safe, well-tolerated and effective analgesic.


Patients allergic to aspirin or other NSAIDs (ibuprofen, naproxen sodium and many others) should avoid diflunisal. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure. In addition, about 5 percent to 10 percent of patients with asthma cannot tolerate aspirin, diflunisal, related NSAIDs, or COX-2 inhibitors because they will precipitate asthmatic attacks in these so-called aspirin- or NSAID-sensitive asthmatics, which can be life threatening.


Patients with ulcers of the stomach or the small intestine should avoid diflunisal. Patients should avoid alcohol consumption during diflunisal therapy for dental pain because alcohol increases the risk of stomach ulcers and bleeding. Other drugs with which diflunisal may adversely interact include:


The manic-depression drug lithium (Eskalith), which when combined can lead to lithium toxicity

Warfarin (Coumadin) and other anticoagulants, which can lead to bleeding

Oral drugs for diabetes (ie, Diabinase and Orinase), which can lead to low blood sugar

Some high blood pressure medications, including beta blockers (propranolol, brand name Inderal), ACE inhibitors (enalapril, brand name Vasotec), and diuretics (hydrochlorothiazide, brand name Hydrodiuril). Combining any of these with diflunisal may cause elevations in blood pressure.

These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.

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