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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2 or 3 doses. Immediate-release (IR) can be dosed 50 mg TID or 75 mg BID. Extended-release (ER) 100 mg once daily.
* **Pain and Primary Dysmenorrhea:** 50 mg every 8 hours as needed. A 75 mg dose can be given initially, followed by 50 mg every 8 hours if needed.
* **Maximum Daily Dose:** 225 mg for IR formulations. For ER, the maximum is 100 mg once daily. Specific protocols may differ.
## Pediatric Dosing
* **Pain and Inflammation:** Dosing is not well-established for all pediatric populations. For children 12 years and older, a dose of 25 mg every 8 hours may be used for mild to moderate pain or primary dysmenorrhea, with a maximum of 75 mg daily.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but monitor closely. Contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. No specific dose adjustment is recommended for mild to moderate renal impairment, but monitor renal function. Contraindicated in severe renal impairment.
* **Geriatric:** Use lowest effective dose due to increased risk of adverse effects.
## Contraindications
* Known 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 gastrointestinal bleeding or perforation.
* Inflammatory bowel disease.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatotoxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** Diminished antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Diminished diuretic effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Renal Function:** Monitor BUN, creatinine, and urine output, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor LFTs (ALT, AST), especially in patients with hepatic impairment or those on long-term therapy.
* **Gastrointestinal Symptoms:** Monitor for signs and symptoms of bleeding or ulceration (e.g., melena, hematemesis).
* **Cardiovascular Risk Factors:** Assess and manage risk factors.
* **Blood Pressure:** Monitor for increases.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with cardiovascular risk factors should be carefully evaluated before initiating diclofenac.
* Discontinue immediately if signs of hepatic or renal dysfunction, or serious adverse reactions occur.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider for any medical advice or treatment decisions.
