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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling, and redness associated with inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins.
## Primary Indications
* Pain and inflammation associated with osteoarthritis and rheumatoid arthritis.
* Mild to moderate pain.
* Acute gouty arthritis.
* Ankylosing spondylitis.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily. Maximum dose: 150 mg daily.
* **Mild to Moderate Pain, Acute Pain:** 25 mg to 50 mg orally every 6 to 8 hours as needed. Maximum dose: 150 mg daily.
* **Acute Gouty Arthritis:** 50 mg orally three times daily for the first 3 days, followed by 50 mg orally two to three times daily for up to 7 days.
## Pediatric Dosing
Diclofenac is generally not recommended for use in pediatric patients due to safety concerns. Specific dosing is not established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start with a lower dose and monitor closely.
* **Renal Impairment:** Use with caution. Monitor renal function.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, gastritis, peptic ulceration, gastrointestinal bleeding, perforation.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events (myocardial infarction, stroke), hypertension, edema.
* **Renal:** Renal impairment, acute kidney injury.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
## Key Drug Interactions
* **ACE Inhibitors and ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** May reduce diuretic and antihypertensive efficacy; increased risk of renal impairment.
* **Lithium:** Diclofenac may increase lithium levels.
* **Methotrexate:** Diclofenac may increase methotrexate toxicity.
* **Warfarin and other anticoagulants:** Increased risk of bleeding.
## Monitoring
* **Renal function:** Baseline and periodically, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Baseline and periodically, especially in patients with liver disease.
* **Blood pressure:** Monitor for hypertension.
* **Signs and symptoms of GI bleeding:** Monitor for black, tarry stools, hematemesis, or abdominal pain.
* **Signs and symptoms of cardiovascular events:** Monitor for chest pain, shortness of breath, weakness, slurring of speech.
## Clinical Pearls
* Diclofenac carries a boxed warning for increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
* It also carries a boxed warning for serious gastrointestinal adverse events, including bleeding, ulceration, and perforation.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of adverse events.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and professional guidelines before making any clinical decisions.
