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# Diclofenac Oral
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Menstrual pain (dysmenorrhea)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-225 mg per day, divided into 3-4 doses. Usual starting dose: 50 mg TID or 75 mg BID. Maximum: 225 mg/day.
* **Acute Pain:** 50 mg TID as needed. May start with 50 mg, followed by 50 mg 8 hours later if needed, then 50 mg every 6-8 hours thereafter. Maximum: 150 mg/day for the first 2 days.
* **Primary Dysmenorrhea:** 50 mg TID as needed. May start with 50 mg, followed by 50 mg 8 hours later if needed, then 50 mg every 6-8 hours thereafter. Maximum: 200 mg/day for the first day, then 150 mg/day thereafter.
## Pediatric Dosing
Dosing is not established for oral diclofenac in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction.
* **Renal Impairment:** Use with caution. May require dose reduction. Consider alternatives 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Decreased antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (AST, ALT)
* Hemoglobin/hematocrit
* Signs and symptoms of GI bleeding
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Caution in patients with pre-existing GI disease, cardiovascular disease, or renal impairment.
* NSAIDs carry a risk of serious cardiovascular thrombotic events.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment. It is essential to verify current prescribing information and guidelines before administering any medication.
