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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that exerts analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with conditions like osteoarthritis and rheumatoid arthritis
* Dysmenorrhea
## Adult Dosing
* **Pain:** 25 mg to 50 mg every 6 to 8 hours as needed. Maximum dose: 150 mg daily.
* **Osteoarthritis:** 35 mg three times daily or 50 mg two to three times daily. Maximum dose: 150 mg daily.
* **Rheumatoid Arthritis:** 50 mg three times daily or 75 mg twice daily. Maximum dose: 150 mg daily.
* **Dysmenorrhea:** 50 mg every 4 to 6 hours as needed. Maximum dose: 150 mg daily for the first day, then 100 mg daily thereafter.
Specific dosing regimens may vary based on local institutional protocols and patient-specific factors.
## Pediatric Dosing
Diclofenac oral formulations are generally not recommended for pediatric use due to lack of established safety and efficacy data for most indications.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Lower doses may be considered. Monitor for signs of liver dysfunction.
* **Renal Impairment:** Use with caution. Monitor renal function closely, especially in patients with pre-existing renal disease or those at risk for renal complications.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Use the lowest effective dose.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Advanced renal disease.
* Severe hepatic impairment.
* History of gastrointestinal bleeding or perforation related to prior NSAID use.
* Pregnancy (third trimester).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, diarrhea, abdominal pain, constipation, flatulence, peptic ulceration, GI bleeding/perforation.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events, myocardial infarction, stroke, hypertension.
* **Renal:** Renal insufficiency, acute renal failure, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice, hepatic failure.
* **Dermatologic:** Rash, pruritus, urticaria.
* **Other:** Headache, dizziness, fluid retention, edema, tinnitus, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May increase the risk of gastrointestinal ulceration and bleeding; concurrent use is generally not recommended.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **Diuretics:** Reduced diuretic effect; increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors/ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis, abdominal pain).
* **Cardiovascular:** Monitor blood pressure and assess for signs of cardiovascular events.
* **Renal:** Monitor renal function (serum creatinine, BUN) especially in patients with risk factors.
* **Hepatic:** Monitor liver function tests (ALT, AST) periodically, especially with prolonged use or in patients with pre-existing liver disease.
* **Hematologic:** Monitor complete blood count if prolonged therapy is anticipated.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastric irritation.
* Caution in patients with cardiovascular disease, hypertension, asthma, or a history of GI issues.
* Consider concomitant gastroprotective therapy (e.g., PPI) in high-risk patients.
* Avoid in the third trimester of pregnancy due to potential risks to the fetus.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and your healthcare provider for accurate and complete drug information before making any treatment decisions.
