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# Diclofenac Tablets
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Pain associated with rheumatoid arthritis
* Pain associated with ankylosing spondylitis
* Acute pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg PO TID or 75 mg PO BID. Maximum daily dose is 225 mg.
* **Acute Pain:** 50 mg PO TID as needed for pain. Maximum daily dose is 225 mg.
* **Delayed-release:** Generally 75 mg PO BID or 100 mg PO once daily. Maximum daily dose is 225 mg.
* **Extended-release:** Generally 100 mg PO once daily. Maximum daily dose is 100 mg.
* *Note: Dosing can vary based on specific product formulation and local protocol.*
## Pediatric Dosing
* **Rheumatoid Arthritis:** 2-12 years: 1-3 mg/kg/day divided into 2-3 doses. Do not exceed adult maximum doses.
* *Safety and efficacy in children younger than 2 years have not been established for all indications.*
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is routinely recommended, but monitor for signs of renal toxicity.
* **Hepatic Impairment:** Use with caution. May require dose reduction in patients with mild to moderate hepatic impairment. Avoid use in severe hepatic 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, flatulence, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, and perforation, renal toxicity, hepatotoxicity, severe skin reactions, exacerbation of hypertension, heart failure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and potential for additive pharmacodynamic effects.
* **ACE inhibitors, ARBs, Diuretics:** Decreased antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **GI bleeding/ulceration:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Cardiovascular risk:** Assess for history of cardiovascular disease and risk factors.
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic function:** Monitor liver enzymes, especially in patients with hepatic impairment or those on long-term therapy.
* **Blood pressure:** Monitor for increases in blood pressure.
## Clinical Pearls
* Lowest effective dose for the shortest duration necessary to minimize risk.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications.
* NSAIDs can mask signs of infection.
* Discontinue immediately if signs of serious cardiovascular events, GI bleeding, or hepatic/renal dysfunction occur.
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*This information is intended for healthcare professionals and does not replace current prescribing information. Always verify with the most up-to-date drug monograph or product labeling.*
