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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Available in immediate-release (IR) and delayed-release (DR) formulations.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with conditions like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute musculoskeletal disorders.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* IR: 150 mg daily in 3 divided doses (50 mg TID).
* DR: 75 mg BID or 100 mg once daily.
* **Acute Pain/Musculoskeletal Disorders:**
* IR: 50 mg TID for the first day, then 50 mg BID or TID thereafter.
* Maximum daily dose: 150 mg (IR or DR).
## Pediatric Dosing
* **Rheumatoid Arthritis:**
* Children 1 to 12 years: 1-3 mg/kg/day divided into 2-4 doses. Maximum daily dose: 75 mg.
* Dosing for other indications or age groups may vary and often relies on specific pediatric guidelines or clinician judgment.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment recommended, but monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. No specific dose adjustment recommended, but monitor renal function. Avoid in severe renal impairment.
* **Elderly:** Use with caution, starting at the lower end of the dosage range due to increased risk of adverse effects.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events (MI, stroke), hypertension.
* **Renal:** Renal insufficiency, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Other:** Headache, dizziness, rash, hypersensitivity reactions, fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity. Monitor lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Renal Function:** Serum creatinine, BUN, especially in patients with pre-existing renal disease or risk factors.
* **Hepatic Function:** LFTs, particularly in patients with hepatic impairment or those on long-term therapy.
* **Blood Pressure:** Monitor for hypertension.
* **Signs of GI Bleeding:** Melena, hematemesis, abdominal pain.
* **Cardiovascular Risk Factors:** Assess and manage appropriately.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
* Be aware of the cardiovascular risk associated with NSAIDs; avoid in patients with recent MI or stroke.
* Delayed-release formulations should not be crushed or chewed.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and local protocols for definitive guidance.
