Please check your internet connection and try again.
# Diclofenac Tablet
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain and inflammation associated with osteoarthritis
* Pain and inflammation associated with rheumatoid arthritis
* Pain and inflammation associated with ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg orally per day, divided into 3 doses (e.g., 50 mg BID with an additional 50 mg dose at bedtime or 75 mg BID).
* **Acute Pain:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Maximum 150 mg in the first 24 hours.
* **Primary Dysmenorrhea:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Maximum 200 mg on the first day.
* **Maximum Daily Dose:** Generally 150 mg/day for chronic use. Higher doses may be used for short periods if clinically indicated and tolerated, but this increases the risk of adverse effects.
## Pediatric Dosing
Diclofenac is generally **not recommended** for use in children under 16 years of age due to a lack of established safety and efficacy data.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. A lower starting dose and careful monitoring are recommended. Dose reduction may be necessary in patients with mild to moderate hepatic impairment. Contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Patients with renal impairment may be at increased risk of renal toxicity. Dose adjustment may be necessary based on renal function. Contraindicated in severe renal impairment.
* **Elderly:** Elderly patients are at increased risk for NSAID-related adverse effects, including gastrointestinal bleeding, cardiovascular events, and renal impairment. Consider a lower dose and careful monitoring.
## 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
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, flatulence, GI bleeding (including ulceration and perforation)
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
* **Renal:** Renal impairment, renal failure, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus, urticaria.
* **Hematologic:** Anemia, thrombocytopenia.
* **Other:** Headache, dizziness, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **Diuretics:** Reduced antihypertensive effect and increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal.
## Monitoring
* **Renal function:** Serum creatinine, BUN, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Liver function:** AST, ALT, bilirubin, especially in patients with hepatic impairment or those on long-term therapy.
* **Gastrointestinal:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis).
* **Cardiovascular:** Blood pressure, signs of fluid retention.
## 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.
* Assess cardiovascular risk before initiating chronic NSAID therapy.
* Discontinue diclofenac immediately if signs of serious adverse events (e.g., cardiovascular events, severe GI bleeding, hepatic failure) occur.
***
**Disclaimer:** This information is intended for healthcare professionals. Always refer to the most current prescribing information and consult with a pharmacist or physician for individual patient management.
