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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum daily dose is 150 mg.
* **Acute Pain:** 50 mg orally every 4 to 6 hours as needed. Maximum daily dose is 150 mg.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum daily dose is 150 mg.
* **Extended-release formulations:** Typically 100 mg to 200 mg once daily.
## Pediatric Dosing
Established pediatric dosing is not widely available for oral diclofenac. Dosing in pediatric patients is generally based on institutional protocols or extrapolation from adult data and specific age groups.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is recommended, but patients with severe renal impairment may require lower doses or more frequent monitoring.
* **Hepatic Impairment:** Use with caution. Patients with hepatic impairment may require lower doses.
## Contraindications
* Known 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:** Gastrointestinal upset, nausea, abdominal pain, diarrhea, dyspepsia, headache, dizziness.
* **Serious:**
* Cardiovascular thrombotic events (myocardial infarction, stroke)
* Gastrointestinal bleeding, ulceration, and perforation
* Hepatotoxicity
* Nephrotoxicity
* Fluid retention and edema
* Hypertension
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (AST, ALT)
* Complete blood count (CBC)
* Blood pressure
* Signs and symptoms of gastrointestinal bleeding.
## Clinical Pearls
* Consider the lowest effective dose for the shortest duration necessary.
* Patients with underlying cardiovascular disease or risk factors should be monitored closely.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and closely monitored.
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**Disclaimer:** This information is intended for clinical decision support only and does not replace professional medical judgment or current prescribing information. Always consult the most recent official drug information and institutional protocols before administering any medication.
