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# Diclofenac Tablets
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain (e.g., postoperative, musculoskeletal)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Immediate-release (IR): 150 mg/day divided into 2-3 doses. Maximum: 225 mg/day.
* Delayed-release (DR): 75 mg once daily or 150 mg/day divided into 2-3 doses. Maximum: 225 mg/day.
* Extended-release (ER): 100 mg once daily. Maximum: 100 mg/day.
* **Acute Pain:**
* IR: 50 mg every 8 hours as needed. Maximum: 150 mg/day.
* DR: 50 mg every 8 hours as needed. Maximum: 150 mg/day.
* **Primary Dysmenorrhea:**
* IR: 50 mg every 8 hours as needed. Maximum: 150 mg/day.
## Pediatric Dosing
Dosing in children is less established and generally reserved for specific indications under specialist guidance. For juvenile idiopathic arthritis, a common range is 2-3 mg/kg/day divided into 2-3 doses, not exceeding adult maximums.
## Dose Adjustments
No specific dose adjustments are routinely required for hepatic or renal impairment, but caution is advised. Lower doses should be used in elderly patients and those with cardiovascular risk factors or gastrointestinal history.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active gastrointestinal bleeding or perforation.
* History of GI bleeding or perforation related to previous NSAID use.
* Active peptic ulceration or bleeding.
* Severe hepatic impairment.
* Severe renal impairment (CrCl < 30 mL/min).
* Heart failure (NYHA II-IV).
* Treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Abdominal pain, dyspepsia, nausea, diarrhea, constipation, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal failure, hepatic failure, hypertension, fluid retention, edema, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## 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:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Blood pressure.
* Renal function (serum creatinine, BUN).
* Liver function tests (LFTs).
* Complete blood count (CBC) for signs of occult bleeding.
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
* Be aware of the increased risk of cardiovascular and gastrointestinal events, especially with prolonged use or higher doses.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals. Always verify current prescribing information with the official product labeling and consult relevant clinical guidelines before making treatment decisions.*
