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# Diclofenac Sodium Tablets
## Overview
Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis and rheumatoid arthritis. It works by reducing hormones that cause inflammation and pain in the body.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain management (mild to moderate)
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis:** 250 mg orally once daily in divided doses, or 150 mg orally once daily in divided doses. Usual dose: 100-150 mg/day divided into 2-3 doses. Maximum: 225 mg/day.
* **Rheumatoid Arthritis:** 250 mg orally once daily in divided doses, or 150 mg orally once daily in divided doses. Usual dose: 150-200 mg/day divided into 3-4 doses. Maximum: 225 mg/day.
* **Ankylosing Spondylitis:** 250 mg orally once daily in divided doses, or 150 mg orally once daily in divided doses. Usual dose: 100-125 mg/day divided into 3-4 doses. Maximum: 225 mg/day.
* **Acute Pain:** 50 mg orally every 6-8 hours as needed. Maximum: 200 mg/day.
* **Dysmenorrhea:** 50 mg orally every 6-8 hours as needed, or a loading dose of 500 mg orally followed by 50 mg every 8 hours for the first day. Maximum: 200 mg/day for subsequent days.
Dose and frequency should be individualized based on patient response and tolerability. The lowest effective dose should be used for the shortest duration necessary.
## Pediatric Dosing
Diclofenac is generally not recommended for use in pediatric patients due to safety concerns and lack of established dosing guidelines.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Monitor liver function. Dose reduction may be necessary.
* **Renal Impairment:** Use with caution. Monitor renal function. Not recommended in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID administration.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Children < 14 years of age for certain formulations (e.g., enteric-coated tablets).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, diarrhea, constipation, abdominal pain, GI bleeding, ulceration.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension.
* **Renal:** Renal insufficiency, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, drowsiness, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of GI bleeding.
* **Diuretics and ACE inhibitors:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Baseline and periodically.
* **Hepatic function:** Baseline and periodically, especially in patients with pre-existing liver disease.
* **Blood pressure:** Monitor regularly.
* **Signs and symptoms of GI bleeding:** Educate patients to report any black, tarry stools or vomiting blood.
* **Cardiovascular risk factors:** Assess and manage appropriately.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI complications.
* Use the lowest effective dose for the shortest duration needed to minimize risk.
* Be aware of the black box warnings for cardiovascular thrombotic events, myocardial infarction, and stroke.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete details and to verify dosing and safety information before administering any medication.
