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# Diclofenac (Tablet)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties via non-selective inhibition of cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Short-term management of acute pain (e.g., dysmenorrhea, post-operative pain)
## Adult Dosing
* **Osteoarthritis:** 50 mg BID or TID, or 75 mg BID (Max: 150 mg/day).
* **Rheumatoid Arthritis:** 50 mg TID or QID, or 75 mg BID (Max: 225 mg/day).
* **Ankylosing Spondylitis:** 25 mg QID, with an extra 25 mg dose at bedtime if necessary (Max: 125 mg/day).
* **Acute Pain:** 50 mg TID.
## Pediatric Dosing
* **Juvenile Rheumatoid Arthritis (≥1 year):** 2–3 mg/kg/day divided into 2–4 doses. Maximum dose is usually 3 mg/kg/day.
* *Note:* Use in children should be monitored by a pediatric specialist; verify strength availability as tablets may not be appropriate for all pediatric weights.
## Dose Adjustments
* **Renal Impairment:** Avoid in severe renal impairment (CrCl <30 mL/min). Use with caution in mild-to-moderate impairment.
* **Hepatic Impairment:** Contraindicated in severe hepatic impairment. Lower starting doses are recommended for mild-to-moderate cases.
* **Geriatric:** Use the lowest effective dose for the shortest duration due to increased risk of GI bleeding and renal insufficiency.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Coronary artery bypass graft (CABG) surgery (perioperative management).
* Active peptic ulcer disease or GI bleeding.
* Third trimester of pregnancy (risk of premature closure of the ductus arteriosus).
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, constipation, dizziness, headache.
* **Serious:** GI bleeding/perforation, myocardial infarction, stroke, fluid retention/edema, acute renal failure, hepatotoxicity (elevated transaminases).
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Decreased antihypertensive efficacy and increased risk of acute kidney injury.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **Lithium/Methotrexate:** Decreased renal clearance, leading to potential toxicity.
## Monitoring
* **Baseline/Periodic:** Serum creatinine/BUN, electrolytes, CBC (to check for anemia/leukopenia), liver function tests (LFTs) if long-term therapy is planned.
* **Clinical:** Monitor blood pressure, signs of GI ulceration (occult blood, anemia), and edema.
## Clinical Pearls
* **GI Protection:** Consider co-administration with a proton pump inhibitor (PPI) or misoprostol if the patient is at high risk for GI complications.
* **Cardiovascular Risk:** Use the lowest effective dose for the shortest duration possible, as all NSAIDs carry a black box warning for increased risk of serious cardiovascular thrombotic events.
* **Administration:** Take with food or milk to minimize GI irritation. Do not crush, chew, or break extended-release formulations.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribing practices vary by region and clinical context. Always consult the latest FDA-approved labeling or institutional protocols before prescribing or administering medication.
