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# Diclofenac (Tablet)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Short-term management of acute pain (varies by formulation/salt: sodium vs. potassium).
## Adult Dosing
* **Osteoarthritis:** 50 mg PO BID or TID, or 75 mg PO BID (Immediate-release); 100 mg PO daily (Extended-release).
* **Rheumatoid Arthritis:** 50 mg PO TID or QID (Immediate-release).
* **Ankylosing Spondylitis:** 25 mg PO QID, plus 25 mg at bedtime if needed.
* **Maximum Dose:** Generally 150 mg/day for immediate-release formulations.
## Pediatric Dosing
* **Use is generally off-label.** Safety and efficacy in children <18 years have not been established by the FDA for oral tablets.
* Consult institutional protocols or pediatric specialty guidelines for niche applications (e.g., JIA).
## Dose Adjustments
* **Renal Impairment:** Avoid in advanced renal disease (CrCl <30 mL/min). Use with caution in mild-to-moderate impairment; monitor closely.
* **Hepatic Impairment:** Avoid in severe hepatic impairment. Use the lowest effective dose in mild-to-moderate impairment.
## Contraindications
* Known hypersensitivity (including urticaria or asthma) to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or peptic ulcer disease.
## Adverse Effects
* **Gastrointestinal:** Nausea, dyspepsia, GI ulceration, bleeding, perforation.
* **Cardiovascular:** Hypertension, edema, increased risk of myocardial infarction or stroke (black box warning).
* **Renal/Hepatic:** Elevated liver enzymes (ALT/AST), acute kidney injury, fluid retention.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, SSRIs):** Increased risk of bleeding.
* **Antihypertensives (ACE inhibitors, ARBs, Diuretics):** Reduced efficacy of antihypertensives; increased risk of renal impairment.
* **Lithium/Methotrexate:** Diclofenac may increase serum concentrations and toxicity risk.
* **Other NSAIDs/Corticosteroids:** Increased risk of GI toxicity.
## Monitoring
* **Baseline/Routine:** CBC, SCr, BUN, and liver function tests (LFTs) if long-term therapy is anticipated.
* **Clinical:** Monitor for signs of GI bleeding (occult blood, anemia), BP changes, and peripheral edema.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize GI irritation.
* **Cardiovascular Risk:** Use the lowest effective dose for the shortest duration necessary to control symptoms.
* **Formulations:** Diclofenac sodium and diclofenac potassium are not always bioequivalent; ensure the correct salt is specified if switching forms.
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**Disclaimer:** This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against current local institutional protocols and official prescribing information (package insert) before prescribing or administering medication.
