Please check your internet connection and try again.
# Diclophenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis
* Acute pain (e.g., musculoskeletal injuries, post-operative pain, dysmenorrhea)
## Adult Dosing
* **Osteoarthritis/Rheumatoid Arthritis:** 150-200 mg per day divided into 2-3 doses. Maximum 200 mg/day.
* **Acute Pain:** 50 mg every 8 hours as needed. Or, 75 mg twice daily. Maximum 150 mg/day for acute pain.
* **Dysmenorrhea:** 50 mg three times daily as needed. Maximum 200 mg/day.
* **Topical (e.g., gel):** Apply to affected area 3-4 times daily.
*Note: Specific dosing may vary based on formulation and local protocols.*
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg per day divided into 2-4 doses. Maximum 200 mg/day. (Generally not recommended for children under 1 year old).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require reduced dose.
* **Renal Impairment:** Use with caution. Monitor for signs of renal toxicity. Avoid if severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking NSAIDs or aspirin
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
* Active peptic ulceration or bleeding
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, elevated liver enzymes, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, perforation, renal toxicity, hepatic failure, hypersensitivity reactions, exacerbation of heart failure, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **ACE inhibitors/ARBs:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic effect, increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **SSRIs:** Increased risk of gastrointestinal bleeding.
## Monitoring
* **Baseline and periodic:** Liver function tests (ALT, AST), renal function tests (creatinine, BUN).
* **Monitor for:** Signs of gastrointestinal bleeding (melena, hematemesis), cardiovascular events, fluid retention, and edema.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotection (e.g., PPI) in patients with increased risk of gastrointestinal complications.
* Risk of serious cardiovascular thrombotic events may occur early in treatment and may increase with duration of use.
* Discontinue if new onset of severe headache, neurological symptoms, or visual disturbances occur.
---
*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment. Verify current prescribing information for complete details and potential updates.*
