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# Diclofenac Tablets ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling, and stiffness associated with osteoarthritis and rheumatoid arthritis. It works by reducing hormones that cause inflammation and pain in the body. ## Primary Indications * Osteoarthritis * Rheumatoid arthritis * Ankylosing spondylitis * Acute pain (e.g., musculoskeletal pain, dental pain, menstrual pain) ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** * Immediate-release: 150 mg daily in 3 divided doses (e.g., 50 mg TID). Maximum 225 mg/day. * Delayed-release: 75 mg to 100 mg daily. May be given as one 75 mg dose or two 37.5 mg doses or one 100 mg dose. Maximum 225 mg/day. * Extended-release: 100 mg once daily. Can be increased to 200 mg once daily if needed. * **Acute Pain:** * 200 mg on the first day, then 150 mg daily in divided doses. * For menstrual pain, 50 mg TID as needed, up to 200 mg/day. * **Dosage depends on indication and formulation. Always refer to specific product labeling.** ## Pediatric Dosing Diclofenac is **not generally recommended** for use in children under 16 years of age for its primary indications. Specific pediatric indications and dosing are limited and depend on the formulation and local protocol. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Start with a lower dose. Avoid in severe hepatic impairment. * **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment. * **Elderly:** Increased risk of GI bleeding, renal, cardiovascular, and hepatic reactions. Consider lower doses. ## Contraindications * 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. * Known **gastrointestinal perforation or obstruction**. * **Active peptic ulceration or bleeding.** ## Adverse Effects * **Gastrointestinal:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, GI bleeding, perforation, ulceration. * **Cardiovascular:** Hypertension, edema, myocardial infarction, stroke. * **Renal:** Renal impairment, acute kidney injury. * **Hepatic:** Elevated liver enzymes, hepatitis, jaundice. * **Dermatologic:** Rash, pruritus. * **Other:** Headache, dizziness, tinnitus, bronchospasm. ## Key Drug Interactions * **ACE inhibitors, ARBs, diuretics:** Increased risk of renal impairment. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding. * **SSRIs:** Increased risk of GI bleeding. * **Lithium, Methotrexate:** Increased serum levels and toxicity. ## Monitoring * **GI symptoms:** Assess for signs of bleeding or ulceration. * **Renal function:** Monitor BUN, creatinine, especially in patients with risk factors. * **Liver function:** Monitor LFTs, especially with long-term use or underlying liver disease. * **Blood pressure:** Monitor for new onset or worsening hypertension. * **Signs of cardiovascular events:** Advise patients to seek immediate medical attention for chest pain, shortness of breath, weakness, slurring of speech. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary. * Administer with food or milk to minimize GI upset. * Delayed-release and extended-release formulations should not be crushed or chewed. * Concomitant use with other NSAIDs, including aspirin, increases the risk of adverse effects. * NSAIDs carry a risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. **Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.