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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum total daily dose: 225 mg.
* **Acute Pain:** 50 mg orally every 4 to 6 hours as needed. Maximum total daily dose: 150 mg for the first day, then 100 mg daily thereafter.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum total daily dose: 150 mg.
* **Extended-Release Formulations:** Varies by product; consult specific product labeling.
## Pediatric Dosing
* Limited data for use in pediatric patients. Safety and efficacy have not been established for most age groups. Consult specific pediatric guidelines or literature for off-label use.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Lower doses may be appropriate.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
* **Elderly:** Increased risk of adverse effects; consider lower doses and careful monitoring.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, rash, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hypertension, renal failure, hepatic failure, hypersensitivity reactions, anaphylaxis.
## 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:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **GI:** Signs and symptoms of GI bleeding or ulceration.
* **Cardiovascular:** Blood pressure, signs of MI or stroke.
* **Renal:** Renal function (BUN, creatinine).
* **Hepatic:** Liver function tests (LFTs).
* **Electrolytes:** Especially in patients with renal impairment or those on diuretics.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Consider co-prescription with a proton pump inhibitor (PPI) for patients at increased risk of GI events.
* NSAIDs carry a boxed warning for cardiovascular risk and GI risk.
* Concurrent use with other NSAIDs should be avoided.
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*Please verify this information with the most current prescribing information and relevant clinical guidelines before use.*
