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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily, or 75 mg orally twice daily. Maximum daily dose: 150 mg.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Maximum daily dose: 150 mg.
* **Primary Dysmenorrhea:** 50 mg orally 3 times daily as needed. Maximum daily dose: 150 mg.
*Note: Dosing for specific formulations (e.g., extended-release, topical) will differ. Consult product labeling.*
## Pediatric Dosing
Limited data for pediatric use. Generally not recommended for children under 16 years for juvenile arthritis. Consult specific product information for any approved pediatric indications and dosing.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised due to potential for renal toxicity with NSAIDs. Use the lowest effective dose for the shortest duration necessary.
## 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
Common: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness, rash.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic injury; hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive efficacy and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **CYP2C9 inhibitors (e.g., fluconazole):** May increase diclofenac exposure.
## Monitoring
* **Renal function:** Serum creatinine, BUN, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic function:** Liver enzymes (AST, ALT), especially with prolonged use or in patients with hepatic impairment.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Cardiovascular risk factors:** Assess and manage appropriately.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration possible to minimize risks of serious adverse events.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of gastrointestinal complications.
* Patients with heart failure or hypertension should be monitored closely.
* Diclofenac is available in various formulations; select based on clinical indication and patient factors.
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**Disclaimer:** This information is intended for clinical professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and product labeling for diclofenac before making any treatment decisions. Local protocols may influence specific dosing and management.
