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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain (e.g., musculoskeletal injuries, dental pain)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Starting dose: 50 mg orally three times daily.
* Usual maintenance dose: 100-150 mg orally per day, divided into 2-3 doses.
* Maximum: 225 mg/day.
* **Acute Pain, Primary Dysmenorrhea:**
* Starting dose: 50 mg orally three times daily.
* Alternatively, an initial dose of 100 mg orally, followed by 50 mg orally as needed.
* Maximum: 200 mg/day.
Dosing should be individualized based on patient response and tolerability. The lowest effective dose should be used.
## Pediatric Dosing
Limited data for oral diclofenac in children. Generally not recommended for children under 12 years old for most indications. Specific indications and dosing may exist for certain formulations or conditions; consult specialized pediatric resources.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses in patients with mild to moderate hepatic impairment. Contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Consider lower doses in patients with mild to moderate renal impairment. Contraindicated in severe renal impairment.
* **Elderly:** Increased risk of GI bleeding, renal, cardiovascular, and hepatic adverse effects. Use with caution and the lowest effective dose.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* History of GI bleeding or perforation related to prior NSAID use.
* Severe hepatic impairment.
* Severe renal impairment.
* Heart failure, ischemic heart disease, peripheral arterial disease.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, headache, dizziness, rash.
* **Serious:**
* **Cardiovascular:** Myocardial infarction, stroke, hypertension, fluid retention, edema.
* **Gastrointestinal:** Bleeding, ulceration, perforation, esophagitis, pancreatitis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice, hepatic failure.
* **Renal:** Acute kidney injury, interstitial nephritis, papillary necrosis.
* **Hematologic:** Anemia, thrombocytopenia, leukopenia.
* **Dermatologic:** Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hypersensitivity:** Anaphylaxis, asthma exacerbation.
## Key Drug Interactions
* **ACE Inhibitors, ARBs, Beta-blockers:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** May decrease diuretic effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Diclofenac may increase serum concentrations of these drugs.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **CYP2C9 Inhibitors/Inducers:** May affect diclofenac metabolism.
## Monitoring
* **Baseline and periodic:** Renal function (serum creatinine, BUN), liver function tests (ALT, AST), complete blood count.
* **For prolonged use:** Monitor for signs and symptoms of GI bleeding, cardiovascular events, and renal dysfunction.
* **Blood pressure:** Monitor, especially in patients with hypertension.
## Clinical Pearls
* Administer with food or milk to reduce GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* NSAID-associated GI, cardiovascular, and renal risks are dose-dependent.
* Advise patients to report any signs of GI bleeding (e.g., black stools, coffee-ground emesis), cardiovascular events (e.g., chest pain, shortness of breath), or allergic reactions.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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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 your institution's protocols before making any treatment decisions.*
