Tab%25252525252525252525252525252525252525252520diclofenac

# Diclofenac (Tablet) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic and anti-inflammatory properties by inhibiting cyclooxygenase-1 and -2 (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. ## Primary Indications * Osteoarthritis (OA) * Rheumatoid arthritis (RA) * Ankylosing spondylitis * Mild to moderate pain and primary dysmenorrhea (IR formulations) ## Adult Dosing * **Osteoarthritis:** 100–150 mg/day in divided doses (e.g., 50 mg twice or three times daily). * **Rheumatoid Arthritis:** 150–200 mg/day in divided doses (e.g., 50 mg three or four times daily). * **Ankylosing Spondylitis:** 100–125 mg/day in divided doses (25 mg four times daily + 25 mg at bedtime). * **Maximum Dose:** Generally 200 mg/day (varies by formulation and product-specific labeling). ## Pediatric Dosing Safety and efficacy for oral diclofenac in children <18 years are not well established. Use is generally avoided or reserved for specialist rheumatology referral. Pediatric dosing guidelines are not standardized. ## Dose Adjustments * **Renal Impairment:** Avoid in severe renal impairment (CrCl <30 mL/min). Use with caution in mild-to-moderate impairment; monitor renal function closely. * **Hepatic Impairment:** Use with caution. Consider lower starting doses in patients with mild-to-moderate cirrhosis; contraindicated in severe hepatic impairment. * **Geriatric:** Use the lowest effective dose for the shortest duration due to increased risk of gastrointestinal (GI) and cardiovascular toxicity. ## Contraindications * Known hypersensitivity to diclofenac or any product component. * History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Setting of coronary artery bypass graft (CABG) surgery. * Active GI bleeding or ulceration. ## Adverse Effects * **Common:** Dyspepsia, nausea, abdominal pain, constipation, diarrhea. * **Serious:** GI bleeding/ulceration, cardiovascular events (MI, stroke), hypertension, fluid retention/edema, hepatotoxicity (elevated liver enzymes), acute renal failure. ## Key Drug Interactions * **Anticoagulants (e.g., Warfarin):** Increased risk of major bleeding. * **Antiplatelets/SSRIs:** Increased risk of GI bleeding. * **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment (nephrotoxicity). * **Lithium/Methotrexate:** Increased serum concentrations and toxicity risk. * **NSAIDs/Corticosteroids:** Increased risk of GI ulceration and bleeding. ## Monitoring * Baseline and periodic serum creatinine/BUN (especially in high-risk groups). * Liver function tests (LFTs) if long-term therapy is used. * Monitor blood pressure. * Assess for occult or overt signs of GI bleeding or fluid retention. ## Clinical Pearls * **GI Protection:** Consider adding a proton pump inhibitor (PPI) or misoprostol if the patient is at high risk for GI complications. * **CV Risk:** Diclofenac carries a black box warning for increased risk of serious cardiovascular thrombotic events. Use the lowest dose for the shortest possible duration. * **Formulations:** IR (Immediate Release) and DR (Delayed Release/Enteric Coated) tablets are not interchangeable with extended-release formulations or potassium/sodium salt variations without confirming the specific product labeling. ***Educational Disclaimer:** This information is for educational purposes only. Clinical practice and dosing protocols vary by institution and patient-specific factors. Always verify current prescribing information, package inserts, and hospital-specific guidelines prior to administering or prescribing medication.*