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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Acute pain
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Dysmenorrhea
## Adult Dosing
* **Immediate-release:**
* Pain: 25 mg to 50 mg every 6 to 8 hours as needed. Maximum daily dose: 150 mg.
* Arthritis: 35 mg to 50 mg twice daily. Maximum daily dose: 150 mg.
* **Delayed-release:**
* Arthritis: 75 mg twice daily or 100 mg once daily.
* **Extended-release:**
* Arthritis: 100 mg once daily or 75 mg twice daily. Maximum daily dose: 175 mg.
Dosing for acute pain may vary based on local protocol and the specific formulation used.
## Pediatric Dosing
Diclofenac is generally not recommended for children under 14 years of age due to limited safety and efficacy data, except in specific cases under specialist guidance.
## Dose Adjustments
* **Hepatic impairment:** Use with caution. Start at the lower end of the dose range.
* **Renal impairment:** Use with caution. Monitor renal function closely. Avoid in severe renal impairment.
## Contraindications
* Known 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.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and new or worsened heart failure.
* **Renal:** Renal insufficiency, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Other:** Headache, dizziness, rash, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (ALT, AST)
* Complete blood count (CBC)
* Signs and symptoms of GI bleeding
* Cardiovascular risk factors
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events.
* Consider gastroprotective agents (e.g., proton pump inhibitors) in patients at high risk for GI complications.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution and only if clearly needed.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
