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# Diclofenac Tablets
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, inflammation, and stiffness.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Acute pain management.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** Typically 50 mg two to three times daily, or 75 mg twice daily. Maximum daily dose is 225 mg. Extended-release formulations may be dosed once or twice daily.
* **Acute Pain:** Immediate-release: 50 mg every 8 hours as needed.
* **Primary Dysmenorrhea:** Immediate-release: 50 mg three times daily as needed, or 100 mg as a single initial dose, followed by 50 mg every 8 hours as needed.
Dosing should be individualized to the lowest effective dose.
## Pediatric Dosing
Diclofenac is generally not recommended for pediatric use due to limited data and increased risk of adverse effects, particularly gastrointestinal.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised due to potential for renal toxicity. Use lowest effective dose and monitor closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* History of GI bleeding or perforation related to prior NSAID use.
* Severe hepatic or renal impairment.
* Heart failure.
## Adverse Effects
* **Common:** Gastrointestinal upset (dyspepsia, nausea, diarrhea), headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), serious gastrointestinal bleeding, ulceration, perforation, renal papillary necrosis, acute renal failure, hepatotoxicity (including severe liver injury), hypersensitivity reactions, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive efficacy; increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations and toxicity.
* **CYP2C9 Inhibitors (e.g., fluconazole):** May increase diclofenac exposure.
## Monitoring
* **GI Symptoms:** Assess for signs of bleeding or ulceration.
* **Renal Function:** Monitor BUN, creatinine, especially in patients with risk factors.
* **Hepatic Function:** Monitor LFTs, especially with prolonged use or in patients with liver disease.
* **Blood Pressure:** Monitor for hypertension.
* **Cardiovascular Risk:** Assess for signs and symptoms of MI or stroke.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastric irritation.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* NSAIDs carry a boxed warning for cardiovascular thrombotic events and serious GI bleeding.
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*This information is intended for healthcare professionals and does not substitute for a thorough review of the complete prescribing information or consultation with a physician. Always verify current prescribing information for accuracy and completeness.*
