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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Pain associated with osteoarthritis
* Pain associated with rheumatoid arthritis
* Pain associated with ankylosing spondylitis
* Mild to moderate pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 250 mg or 325 mg enteric-coated tablets every 6 to 8 hours as needed. Maximum daily dose is typically 1000 mg.
* **Mild to Moderate Pain:** 250 mg or 325 mg enteric-coated tablets every 4 to 6 hours as needed. Maximum daily dose is typically 1000 mg.
* *Note: Dosing for specific formulations (e.g., delayed-release, immediate-release) may vary. Always refer to product-specific labeling.*
## Pediatric Dosing
Diclofenac oral formulations are generally not recommended for pediatric use due to lack of established safety and efficacy.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose and monitor closely.
* **Renal Impairment:** Use with caution. Monitor renal function.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Gastrointestinal upset (dyspepsia, nausea, abdominal pain), diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), serious GI bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, anaphylaxis, severe skin reactions (e.g., Stevens-Johnson syndrome).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (LFTs).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Consider the risk of GI bleeding and cardiovascular events, especially in high-risk patients.
* Advise patients to report any signs of bleeding, black tarry stools, severe stomach pain, or any new or worsening cardiovascular symptoms.
* Enteric-coated tablets should be swallowed whole and not crushed or chewed.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for definitive guidance.*
