Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing the synthesis of prostaglandins.
## Primary Indications
* Pain management
* Inflammation associated with conditions such as osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
## Adult Dosing
* **Osteoarthritis:** 150-200 mg per day, divided into 2-3 doses. Extended-release formulations: 100 mg once daily.
* **Rheumatoid Arthritis/Ankylosing Spondylitis:** 150-200 mg per day, divided into 2-3 doses.
* **Acute Pain:** Initial dose of 50 mg three times daily.
* **Maximum Daily Dose:** 200 mg per day.
## Pediatric Dosing
* **Pain and Inflammation:** Dosing is not well-established for children under 12 years of age. Consult specific pediatric guidelines or specialist advice.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction; 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.
* **Elderly:** Increased risk of gastrointestinal bleeding, renal, cardiovascular, and hepatic adverse effects. Consider lower doses and closer monitoring.
## Contraindications
* 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.
* Inflammatory bowel disease.
* Severe heart failure, liver failure, or renal failure.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, flatulence, GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, edema, fluid retention.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Other:** Dizziness, headache, rash, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and additive effects.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **SSRIs:** Increased risk of GI bleeding.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Renal function:** Serum creatinine, BUN.
* **Hepatic function:** Liver enzymes (ALT, AST).
* **Complete blood count (CBC):** Monitor for anemia from occult GI bleeding.
* **Blood pressure:** Especially in patients with hypertension.
* **Signs and symptoms of GI bleeding:** Melena, hematemesis.
* **Signs and symptoms of cardiovascular events.**
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Patients with cardiovascular risk factors or a history of GI bleeding should be managed with caution, potentially considering alternative agents.
* The risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke may increase with duration of use and in patients with existing cardiovascular risk factors.
***
**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult current prescribing information and your healthcare provider for accurate and up-to-date guidance.
