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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily, or 75 mg orally twice daily. Extended-release formulations: 100 mg orally once daily.
* **Acute Pain:** 50 mg orally 3 times daily as needed.
* **Primary Dysmenorrhea:** Initial dose of 50 mg orally, followed by 25-50 mg every 6-8 hours as needed.
* **Maximum Daily Dose:** 150 mg (immediate-release); 200 mg (extended-release).
## Pediatric Dosing
* **Pain and Inflammation (ages 1 year and older):** Dosing is typically based on weight. A common regimen is 1-3 mg/kg/day divided into 2-4 doses. **Specific dosing regimens should be confirmed with local protocols or product labeling as variability exists.**
* **Maximum Daily Dose:** Generally not to exceed the adult maximum.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction, especially in severe impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Dose reduction may be necessary in severe impairment.
## Contraindications
* 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.
* Active peptic ulceration or GI bleeding.
* Late pregnancy (third trimester).
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness.
Serious: Gastrointestinal bleeding, ulceration, perforation, myocardial infarction, stroke, hypertension, renal failure, liver failure, hypersensitivity reactions, 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.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and other adverse effects.
## Monitoring
* **GI bleeding/ulceration:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Cardiovascular risk:** Blood pressure, signs of ischemia.
* **Renal function:** Serum creatinine, BUN, urine output.
* **Hepatic function:** Liver enzymes, bilirubin.
* **Electrolytes.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider co-administration with a proton pump inhibitor (PPI) for patients at increased risk of GI complications.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution.
* Avoid concurrent use with other NSAIDs.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before initiating treatment.*
