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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling, and redness associated with inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
* Gout flares
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily, or 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Acute Pain:** 50 mg orally 3 times daily as needed.
* **Primary Dysmenorrhea:** 50 mg orally 3 times daily as needed. Initial dose: 50 mg, followed by 50 mg every 8 hours. A total daily dose of 200 mg may be used on the first day.
* **Gout Flares:** 50 mg orally 3 times daily for 3-7 days.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day divided into 2-3 doses. Maximum daily dose: 75 mg.
* **Children under 1 year:** Safety and efficacy not established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Monitor liver function. In mild to moderate impairment, a reduction in dose may be considered. Contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. In mild to moderate impairment, no dose adjustment is typically needed, but caution is advised. Contraindicated in severe renal impairment.
## 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.
* Third trimester of pregnancy.
## Adverse Effects
Common: abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, flatulence, rash, dizziness, headache.
Serious: cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hepatic toxicity, renal toxicity, hypertension, fluid retention, edema, anaphylaxis.
## 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.
* **Lithium, Methotrexate:** Increased serum levels and risk of toxicity.
* **CYP2C9 Inhibitors (e.g., Fluconazole):** May increase diclofenac exposure.
## Monitoring
* **Baseline and periodic monitoring of renal and hepatic function.**
* **Monitor for signs and symptoms of GI bleeding or ulceration.**
* **Monitor blood pressure.**
* **Monitor for signs of hypersensitivity reactions.**
## Clinical Pearls
* Lowest effective dose for the shortest duration needed to minimize risks.
* Administer with food or milk to reduce gastric upset.
* Consider GI protective agents (e.g., PPIs) in patients at increased risk of GI bleeding.
* Avoid concomitant use with other NSAIDs.
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*Disclaimer: This information is for educational purposes only and does not substitute professional medical advice. Always consult your healthcare provider or pharmacist to verify the most current prescribing information and for personalized medical advice.*
