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# Diclofenac Tablets
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It is available in various oral formulations.
## Primary Indications
* Pain relief
* Inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
* Primary dysmenorrhea
## Adult Dosing
* **Immediate-release tablets:** Typically 50 mg two to three times daily. Maximum daily dose is 150 mg.
* **Delayed-release tablets:** Typically 25 mg four times daily or 50 mg two to three times daily. Maximum daily dose is 200 mg.
* **Extended-release tablets:** Typically 100 mg once daily or 75 mg twice daily. Maximum daily dose is 150 mg.
* **Acute pain:** Dosing varies by formulation; consult specific product labeling.
Dose and frequency should be individualized to achieve the lowest effective dose.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day divided into 2-4 doses. Maximum daily dose is 75 mg.
Limited data available for other indications in pediatrics.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start at the lowest effective dose. Monitor for adverse effects.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment if possible.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, elevated liver enzymes. Increased risk of GI bleeding, ulceration, and perforation.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events (myocardial infarction, stroke). Hypertension. Fluid retention and edema.
* **Renal:** Renal toxicity, including interstitial nephritis, papillary necrosis, and renal failure.
* **Hepatic:** Elevated transaminases, hepatitis, jaundice.
* **Hypersensitivity:** Rash, pruritus, anaphylaxis.
* **Other:** Headache, dizziness, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI toxicity.
* **ACE inhibitors, ARBs, diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **Other NSAIDs, including aspirin:** Increased risk of adverse effects.
## Monitoring
* **Renal function:** Serum creatinine, BUN.
* **Liver function:** ALT, AST.
* **Blood pressure.**
* **Signs and symptoms of GI bleeding.**
* **Signs and symptoms of cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider concomitant gastroprotective therapy (e.g., PPI) in patients at increased risk for GI events.
* Assess cardiovascular risk before initiating therapy.
* Avoid concomitant use with other NSAIDs.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details before making any treatment decisions.
