Tab%252525252525252525252525252520diclofenac

# Diclofenac ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) with potent analgesic, anti-inflammatory, and antipyretic properties. It acts primarily by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. ## Primary Indications - Osteoarthritis - Rheumatoid arthritis - Ankylosing spondylitis - Acute pain and primary dysmenorrhea - Migraine (specific formulations) ## Adult Dosing *Dosing varies significantly by formulation (immediate-release vs. delayed-release).* - **Oral (Immediate-Release/Potassium):** 50 mg every 8 hours as needed. Maximum 150 mg/day. - **Oral (Delayed-Release/Sodium):** 50 mg 3 times daily or 75 mg 2 times daily. Maximum 150 mg/day. - **Oral (Extended-Release):** 100 mg once daily. Maximum 100 mg/day. ## Pediatric Dosing *Safety and efficacy in children <18 years are not well established for most oral formulations.* - **Juvenile Idiopathic Arthritis (JIA):** 2–3 mg/kg/day divided into 2–4 doses. Maximum 150 mg/day (varies by country/protocol; verify local guidelines). ## Dose Adjustments - **Renal Impairment:** Avoid in severe renal impairment (CrCl <30 mL/min). Use with caution in moderate impairment. - **Hepatic Impairment:** Avoid in severe hepatic impairment. Monitor liver enzymes periodically in long-term therapy. - **Geriatric:** Start at the lowest effective dose; risk of GI toxicity and fluid retention is increased. ## Contraindications - Known hypersensitivity to diclofenac or other NSAIDs (including aspirin-induced asthma/urticaria). - History of GI bleeding or perforation related to NSAID therapy. - Active peptic ulcer disease or inflammatory bowel disease. - Setting of coronary artery bypass graft (CABG) surgery. - Severe renal or hepatic failure. ## Adverse Effects - **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, increased risk of GI ulcers/bleeding. - **Cardiovascular:** Increased risk of thrombotic events (MI, stroke), hypertension, edema. - **Renal:** Acute kidney injury, fluid retention, hyperkalemia. - **Hepatic:** Elevated transaminases (drug-induced hepatotoxicity). ## Key Drug Interactions - **Anticoagulants/Antiplatelets:** Increased risk of bleeding (e.g., warfarin, clopidogrel). - **ACE Inhibitors/ARBs/Diuretics:** Decreased antihypertensive efficacy and increased risk of renal impairment/nephrotoxicity. - **Lithium/Methotrexate:** Decreased renal clearance, leading to increased toxicity. - **Other NSAIDs/Corticosteroids:** Increased risk of gastrointestinal adverse effects. ## Monitoring - **Renal Function:** Monitor serum creatinine and electrolytes during chronic therapy. - **Liver Function:** Baseline and periodic monitoring of ALT/AST, especially during the first few months of therapy. - **Blood Pressure:** Monitor frequently, as NSAIDs can induce or exacerbate hypertension. - **GI Assessment:** Monitor for signs of gastrointestinal bleeding or ulceration. ## Clinical Pearls - **Administration:** Take with food or milk to minimize GI irritation. Do not crush or chew delayed/extended-release formulations. - **Cardiovascular Risk:** NSAIDs may increase the risk of serious CV thrombotic events; use the lowest effective dose for the shortest duration necessary. - **Topicals:** Diclofenac gel is available for localized osteoarthritis; it carries a lower (though not zero) risk of systemic side effects compared to oral formulations. - **Cross-Hypersensitivity:** Patients allergic to aspirin or other NSAIDs should generally avoid diclofenac due to the risk of cross-reactivity. *** **Educational Disclaimer:** This information is intended for educational purposes for healthcare professionals. Clinical practice guidelines and local protocols vary significantly. Always verify specific dosing, safety profiles, and product labeling with the latest prescribing information or your local formulary.