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## Diclofenac Tablets
### Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce inflammation and pain.
### Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate pain
* Primary dysmenorrhea
### Adult Dosing
* **Osteoarthritis:** 350 mg PO TID (maximum 1000 mg/day).
* **Rheumatoid Arthritis, Ankylosing Spondylitis:** 400-600 mg/day divided into 2-4 doses (maximum 600 mg/day).
* **Pain and Dysmenorrhea:** 500 mg PO once, followed by 250 mg PO every 8 hours as needed. Alternatively, 500 mg PO initially, then 250 mg PO every 8 hours for the first day, followed by 250 mg PO every 8-12 hours on subsequent days. Do not exceed 1000 mg on the first day or 750 mg on subsequent days.
### Pediatric Dosing
* **Pain and Dysmenorrhea (age 14 years and older):** 500 mg PO initially, then 250 mg PO every 8 hours as needed. Alternatively, 500 mg PO initially, then 250 mg PO every 8 hours for the first day, followed by 250 mg PO every 8-12 hours on subsequent days. Do not exceed 1000 mg on the first day or 750 mg on subsequent days.
* **Juvenile Rheumatoid Arthritis:** Dosing not established for children under 14 years with this formulation.
### Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is routinely recommended, but patients should be monitored for renal function.
* **Hepatic Impairment:** Use with caution. Start at the lower end of the dose range and monitor liver function tests.
### Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
### Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal failure, hepatic failure, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **ACE inhibitors, ARBs, diuretics:** May diminish antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
### Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Signs and symptoms of gastrointestinal bleeding.
* Blood pressure.
* Signs and symptoms of hypersensitivity reactions.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration should be used to minimize risks.
* Caution in patients with pre-existing cardiovascular disease, renal impairment, or hepatic impairment.
* Avoid concurrent use with other NSAIDs.
**Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details and to verify dosages before administration.
