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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (acute, chronic)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2-3 doses. Maximum dose: 200 mg/day.
* **Pain and Primary Dysmenorrhea:** Initial dose: 50 mg three times daily. Maintenance dose: 50 mg twice daily or 75 mg twice daily as needed. Maximum dose: 200 mg/day.
* **Extended-release formulations:** 100 mg once daily or 200 mg once daily.
Dosing should be individualized to the lowest effective dose.
## Pediatric Dosing
Diclofenac is not generally recommended for pediatric use due to lack of established safety and efficacy.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution, especially in patients with pre-existing renal disease. May require dose reduction in moderate to severe renal impairment. Avoid in severe renal impairment.
## 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.
* Active peptic ulceration or gastrointestinal bleeding.
* Inflammatory bowel disease.
* Heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Gastrointestinal (dyspepsia, nausea, diarrhea, constipation, abdominal pain), headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), serious gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (BUN, creatinine) and electrolytes.
* Liver function tests (AST, ALT).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Extended-release formulations should not be crushed or chewed.
* Risk of cardiovascular events and serious gastrointestinal events increases with dose and duration of use.
* NSAID use can mask signs of infection.
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*Disclaimer: This information is intended for healthcare professionals and does not replace the need to consult current prescribing information, official guidelines, or professional judgment.*
