Please check your internet connection and try again.
# Tab diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) with potent analgesic, anti-inflammatory, and antipyretic effects. Available as oral tablets (immediate-release and delayed-release).
## Primary Indications
- Acute and chronic pain (e.g., osteoarthritis, rheumatoid arthritis, ankylosing spondylitis)
- Acute musculoskeletal injuries, dysmenorrhea, postoperative pain
- Fever (off-label in some regions)
## Adult Dosing
- **Immediate-release**: 50 mg two or three times daily. Max 150 mg/day.
- **Delayed-release**: 50 mg two to three times daily or 75 mg twice daily. Max 150 mg/day.
- **Short-term acute pain**: 75 mg IM or IV (injectable forms) — oral alternative: 100 mg loading dose, then 50 mg three times daily for limited duration.
## Pediatric Dosing
- **Approved for osteoarthritis/juvenile idiopathic arthritis (age ≥1 year)**: 1–3 mg/kg/day in two to three divided doses. Max 150 mg/day (or 3 mg/kg/day, whichever is lower).
- **Acute pain (short-term)**: 1–2 mg/kg/day in two to three divided doses. Max 150 mg/day.
- Dosing varies by local protocol; always refer to pediatric-specific formulations (avoid tablets in small children; use oral suspension or suppositories if available).
## Dose Adjustments
- **Hepatic impairment**: Avoid or reduce dose in severe liver disease. Monitor transaminases.
- **Renal impairment**: CrCl <30 mL/min — avoid use. Mild–moderate impairment — use lowest effective dose.
- **Elderly**: Use lowest effective dose; monitor renal/GI function.
## Contraindications
- Hypersensitivity to diclofenac, aspirin, or other NSAIDs
- Active peptic ulcer or GI bleeding
- Severe heart failure (NYHA III–IV)
- Coronary artery bypass graft (CABG) perioperative pain
- Third trimester of pregnancy
- Significant renal impairment (CrCl <30 mL/min)
## Adverse Effects
- **Common**: Nausea, dyspepsia, diarrhea, headache, dizziness
- **Serious**: GI ulcer/bleeding, hypertension, fluid retention, renal impairment, elevated liver enzymes, thrombotic events (MI, stroke). Increased cardiovascular risk with long-term use.
## Key Drug Interactions
- **Anticoagulants (warfarin, DOACs)**: increased bleeding risk
- **Aspirin/low-dose aspirin**: increased GI risk; avoid concurrent use
- **ACE inhibitors/ARBs/diuretics**: reduced antihypertensive efficacy; increased renal risk
- **Lithium, methotrexate, cyclosporine**: increased toxicity of these agents
- **SSRIs/SNRIs**: additive GI bleeding risk
## Monitoring
- Baseline: CBC, renal function (Cr, BUN), liver enzymes
- Periodic: blood pressure (monitor for new-onset hypertension), renal function, liver enzymes (especially in chronic use)
- Signs/symptoms of GI bleeding or cardiovascular events
## Clinical Pearls
- Take with food or milk to reduce GI irritation.
- Enteric-coated formulations may delay onset; do not crush or chew.
- Diclofenac has higher GI and CV risk compared to ibuprofen or naproxen; reserve for short-term use if possible.
- For acute pain, a single 50–100 mg dose can be effective; limit total duration.
**Disclaimer**: This information is for educational purposes only. Always consult current prescribing information and local guidelines. Dosing may vary by indication, formulation, and patient factors. Verify all doses before administration.
