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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, inflammation, and stiffness.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Acute pain (e.g., postoperative pain, musculoskeletal pain).
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg orally per day, divided into 2-3 doses. Doses can range from 50-200 mg daily.
* **Acute Pain:** 25-50 mg orally every 6-8 hours as needed. Do not exceed 200 mg per day for acute pain.
* **Primary Dysmenorrhea:** 50 mg orally every 8 hours as needed. Initial dose 50 mg, followed by 50 mg doses if necessary. Do not exceed 200 mg on the first day and 150 mg per day thereafter.
## Pediatric Dosing
Diclofenac oral formulations are generally not recommended for pediatric patients due to lack of established safety and efficacy.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate hepatic impairment may not require dose adjustment, but monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution, especially in patients with pre-existing renal disease. Monitor renal function. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Heart failure.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and other adverse effects.
* **ACE inhibitors, ARBs, diuretics:** May decrease antihypertensive effects and increase risk of renal impairment.
* **Lithium, Digoxin:** Increased serum levels.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* **GI:** Signs and symptoms of bleeding, ulceration, and perforation.
* **Cardiovascular:** Blood pressure, signs of heart failure.
* **Renal:** Renal function (BUN, creatinine), urine output.
* **Hepatic:** Liver function tests (LFTs).
* **Hematologic:** Hemoglobin/hematocrit if signs of anemia or bleeding.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with cardiovascular risk factors should be monitored closely.
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*Disclaimer: This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details.*
