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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, providing analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
## Adult Dosing
* **Immediate-release (IR):** 50 mg orally 2 to 3 times daily. Maximum dose: 200 mg/day.
* **Delayed-release (DR):** 75 mg orally 2 times daily. Maximum dose: 225 mg/day.
* **Extended-release (ER):** 100 mg orally once daily or 200 mg orally once daily. Maximum dose: 200 mg/day.
Specific dosing frequency and duration should be guided by patient response and the condition being treated. Local protocols may dictate specific regimens.
## Pediatric Dosing
* **Pain and Inflammation:** 1 to 15 years: 1 to 3 mg/kg/day in 2 to 4 divided doses. Maximum dose: 200 mg/day.
* **Juvenile Rheumatoid Arthritis:** 1 to 15 years: 2 to 3 mg/kg/day in 2 to 4 divided doses. Maximum dose: 200 mg/day.
* **Note:** Dosing in pediatrics requires careful consideration and is often guided by specific clinical guidelines or institutional protocols.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. In mild to moderate impairment, a reduced dose may be considered. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Generally no dose adjustment is needed in mild to moderate renal impairment, but it should be avoided in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness.
Serious: Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, hypertension.
## Key Drug Interactions
* **ACE Inhibitors and ARBs:** Increased risk of renal impairment and decreased antihypertensive effect.
* **Diuretics:** Reduced diuretic effect and increased risk of renal impairment.
* **Anticoagulants (e.g., Warfarin) and Antiplatelets (e.g., Aspirin, Clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI adverse effects.
* **Lithium, Methotrexate:** Increased serum concentrations.
## Monitoring
* **GI Symptoms:** Monitor for signs of bleeding or ulceration.
* **Renal Function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor LFTs, especially with long-term use or in patients with hepatic impairment.
* **Blood Pressure:** Monitor for potential increases.
* **Cardiovascular Risk Factors:** Assess and manage.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk for GI complications.
* Patients with asthma, especially those with aspirin-sensitive asthma, are at increased risk for bronchospasm.
* NSAIDs can mask signs of infection.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details before making any clinical decisions.*
