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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
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2 or 3 doses. Doses of 50 mg TID may be used, but increase risk of GI adverse events. Maximum daily dose is 200 mg.
* **Pain and Primary Dysmenorrhea:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Do not exceed 200 mg in 24 hours.
## Pediatric Dosing
Dosing for children is not well-established for all formulations. Consult specific pediatric guidelines or product information.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. NSAIDs can cause renal injury. In patients with severe hepatic impairment, consider a reduced dose.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following NSAID or aspirin use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active GI bleeding or perforation.
* Inflammatory bowel disease.
* Severe heart failure.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, GI bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension.
* **Renal:** Renal insufficiency, acute kidney injury.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus, fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI:** Monitor for signs and symptoms of GI bleeding and ulceration.
* **Cardiovascular:** Blood pressure, signs of heart failure.
* **Renal:** Renal function (serum creatinine, BUN), especially in patients with risk factors.
* **Hepatic:** Liver function tests (ALT, AST), especially with chronic use or in patients with pre-existing liver disease.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Caution in elderly patients due to increased risk of adverse events.
* NSAIDs can mask signs of infection.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details before making treatment decisions.
