Almiral Dosage/Direction for Use

Dosage: As a general recommendation, the dose should be individually adjusted. Adverse effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms (see PRECAUTIONS).
Adults: The recommended initial daily dose is 100 to 150 mg. In milder cases, as well as for long term therapy, 75 to 100 mg daily is usually sufficient. The total daily dose should generally be divided into 2 to 3 doses. To suppress nocturnal pain and morning stiffness, treatment with tablets during the day can be supplemented by the administration of a suppository at bedtime (up to a total maximum daily dose of 150 mg).
In primary dysmenorrhoea, the daily dose should be individually adjusted and is generally 50 to 150 mg. A dose of 50 to 100 mg should be given initially and, if necessary, increased over the course of several menstrual cycles up to a maximum of 200 mg/day. Treatment should be started on appearance of the first symptoms and, depending on the symptomatology, continued for a few days.
Special populations: Pediatrics: Children aged 1 year or over and adolescents should be given 0.5 to 2 mg/kg body weight daily in 2 to 3 separate doses, depending on the severity of the disorder. For treatment of juvenile rheumatoid arthritis, the daily dose can be raised up to a maximum of 3 mg/kg daily, given in separate doses. Generally, because of the dosage strength, only the 25 mg tablet should be used in children and adolescents.
Geriatrics (Patients aged 65 or above): Although the pharmacokinetics of Almiral are not impaired to any clinically relevant extent in elderly patients, Almiral should be used with particular caution in such patients who generally are more prone to adverse reactions (see PRECAUTIONS).
Established cardiovascular disease or significant cardiovascular risk factors: The use of high dose diclofenac (150 mg/day) for more than 4 weeks is contraindicated in patients with established cardiovascular disease (congestive heart failure, established ischemic heart disease, peripheral arterial disease) or uncontrolled hypertension. If diclofenac treatment is needed, patients with established cardiovascular disease, uncontrolled hypertension or significant cardiovascular risk factors (e.g. hypertension, hyperlipidaemia, diabetes mellitus and smoking) should be treated only after careful consideration and at doses ≤100 mg daily if the treatment is for more than 4 weeks. As the cardiovascular risks of diclofenac may increase with dose and duration of exposure, diclofenac should always be prescribed at the lowest effective daily dose and for the shortest duration possible (see CARDIOVASCULAR EFFECTS under PRECAUTIONS).
Renal impairment: Almiral is contraindicated in patients with renal failure (see CONTRAINDICATIONS).
No specific studies have been carried out in patients with renal impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering Almiral to patients with mild to moderate renal impairment (see PRECAUTIONS).
Hepatic impairment: Almiral is contraindicated in patients with hepatic failure (see CONTRAINDICATIONS).
No specific studies have been carried out in patients with hepatic impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering Almiral to patients with mild to moderate hepatic impairment (see PRECAUTIONS).
Method of administration: The tablets should be swallowed whole with liquid, preferably before meals, and must not be divided or chewed.