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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day in divided doses. A common starting dose is 50 mg three times daily or 75 mg twice daily.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Dysmenorrhea:** 50 mg three times daily as needed, with a maximum of 200 mg on the first day.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most oral diclofenac formulations. Specific formulations like delayed-release or enteric-coated tablets are generally not recommended for children. Consult specific pediatric guidelines or product labeling for any approved indications and doses.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Moderate impairment may require dose reduction. Severe impairment is a contraindication.
* **Renal Impairment:** Use with caution. May require dose reduction in patients with mild to moderate renal impairment. Severe renal impairment is a contraindication.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal (GI) bleeding.
* History of GI bleeding or perforation related to previous NSAID use.
* Severe hepatic impairment.
* Severe renal impairment.
* Heart failure.
* Pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal failure, hepatic failure, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI and renal toxicity.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **GI:** Monitor for signs and symptoms of GI bleeding and ulceration.
* **Renal:** Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* **Hepatic:** Monitor liver function tests (ALT, AST) especially with long-term use or in patients with hepatic impairment.
* **Cardiovascular:** Assess cardiovascular risk factors.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize GI and cardiovascular risks.
* Administer with food or milk to decrease GI upset.
* Enteric-coated or delayed-release formulations may not be absorbed as quickly and should not be crushed or chewed.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for comprehensive prescribing information. Always verify the most current drug information with the official product labeling and local institutional protocols.
