Tab%252525252520diclofenac

# Diclofenac (Tablet) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis via inhibition of COX-1 and COX-2 enzymes. It possesses analgesic, anti-inflammatory, and antipyretic properties. ## Primary Indications - Osteoarthritis - Rheumatoid arthritis - Ankylosing spondylitis - Acute pain or primary dysmenorrhea ## Adult Dosing - **Osteoarthritis:** 50 mg BID or TID, or 75 mg BID. Maximum 150 mg/day. - **Rheumatoid Arthritis:** 50 mg TID or QID, or 75 mg BID. Maximum 225 mg/day. - **Ankylosing Spondylitis:** 25 mg QID plus an extra 25 mg at bedtime if needed. Maximum 125 mg/day. - **Acute Pain/Dysmenorrhea:** 50 mg TID. ## Pediatric Dosing - **Safety and efficacy in children <18 years are not established.** Use is generally avoided or limited to specialized rheumatology protocols. ## Dose Adjustments - **Renal Impairment:** Avoid in severe renal impairment (CrCl <30 mL/min). Use with caution in mild-to-moderate impairment; monitor renal function. - **Hepatic Impairment:** Reduce dose or avoid in patients with active hepatic disease. Monitor liver enzymes (ALT/AST). - **Geriatric:** Start at the lowest effective dose; increased risk of serious GI/CV adverse events. ## Contraindications - Known hypersensitivity to diclofenac or aspirin. - History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. - Preoperative pain management in the setting of coronary artery bypass graft (CABG) surgery. - Active gastrointestinal bleeding or peptic ulcer disease. ## Adverse Effects - **GI:** Dyspepsia, abdominal pain, nausea, peptic ulceration, GI bleeding. - **Cardiovascular:** Increased risk of myocardial infarction and stroke; fluid retention and edema; hypertension. - **Renal:** Acute kidney injury, interstitial nephritis, hyperkalemia. - **Hepatic:** Elevated liver enzymes (rarely, severe hepatotoxicity). ## Key Drug Interactions - **Anticoagulants/Antiplatelets (e.g., Warfarin, SSRIs):** Increased risk of bleeding. - **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment. - **Lithium/Methotrexate:** Diclofenac may increase serum concentrations and toxicity of these agents. - **Other NSAIDs/Corticosteroids:** Increased risk of GI toxicity. ## Monitoring - **Baseline:** CBC, LFTs, SCr/BUN, blood pressure. - **Ongoing:** Periodic assessment of renal function, blood pressure, and hemoglobin/hematocrit if long-term therapy is used. Monitor for signs/symptoms of GI bleeding. ## Clinical Pearls - **Administration:** Take with food or milk to minimize GI upset. Tablets should be swallowed whole; do not crush or chew. - **CV Warning:** All NSAIDs carry a boxed warning for increased risk of serious cardiovascular thrombotic events. - **Duration:** Use the lowest effective dose for the shortest duration necessary to control symptoms. - **Formulations:** Note that systemic absorption varies significantly between oral, topical, and ophthalmic formulations. Ensure the correct salt form (e.g., potassium vs. sodium) is specified, as they may have different pharmacokinetic properties (potassium salt is often used for immediate analgesic effects). *** **Disclaimer:** This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against current institutional protocols, primary literature, and the manufacturer’s official prescribing information (package insert) before prescribing or administering medication.