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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Pain (acute and chronic)
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis:** 150 mg daily, divided into 2 or 3 doses. Extended-release formulations: 100 mg once daily.
* **Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg daily, divided into 2, 3, or 4 doses. Extended-release formulations: 100 mg once daily.
* **Acute Pain:** Initial dose of 150 mg, followed by 50 mg every 8 hours as needed.
* **Dysmenorrhea:** 50 mg three times daily as needed.
* **Maximum Daily Dose:** Generally, 200 mg per day. For specific formulations or indications, the maximum may vary. Always consult the specific product monograph.
## Pediatric Dosing
Limited data available. Diclofenac is generally not recommended for use in children under 16 years of age for pain and inflammation, though it may be used in juvenile idiopathic arthritis at specific doses under specialist supervision. Consult pediatric-specific guidelines if considering use.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Reduced dosage may be necessary in patients with mild to moderate hepatic impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Patients with significant renal impairment may require dose reduction. Monitor renal function closely.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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.
* Heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, elevated liver enzymes, gastritis, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Hypertension, edema, fluid retention, increased risk of thrombotic events (myocardial infarction, stroke).
* **Renal:** Renal impairment, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus, photosensitivity.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors and Angiotensin II Receptor Blockers (ARBs):** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic and antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels, risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of adverse effects, particularly GI and renal.
## Monitoring
* **Renal Function:** Especially in patients with pre-existing renal disease or those at risk.
* **Liver Function Tests:** Particularly with chronic use or in patients with hepatic impairment.
* **Blood Pressure:** Monitor for hypertension.
* **Signs and Symptoms of GI Bleeding:** Melena, hematemesis, abdominal pain.
* **Electrolytes:** If indicated.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with cardiovascular risk factors should be assessed carefully before initiating diclofenac.
* Discontinue if signs of hepatic or renal dysfunction, or serious adverse reactions occur.
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**Disclaimer:** This information is intended for healthcare professionals. It is crucial to consult the most current prescribing information and relevant clinical guidelines for complete details and to confirm dosages and safety information before prescribing or dispensing any medication. Local protocols may dictate specific dosing strategies.
