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# Diclofenac Oral
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis and rheumatoid arthritis. It is also used to treat acute pain, menstrual cramps, and migraine.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
* Migraine
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Enteric-coated tablets: 350 mg once daily or 175 mg twice daily.
* Delayed-release tablets: 100 mg once daily or 50 mg twice daily.
* Maximum dose: 225 mg/day (enteric-coated), 150 mg/day (delayed-release).
* **Acute Pain:**
* Delayed-release tablets: 50 mg three times daily as needed.
* Maximum dose: 150 mg/day.
* **Primary Dysmenorrhea:**
* Delayed-release tablets: 50 mg three times daily as needed.
* Maximum dose: 150 mg/day.
* **Migraine:**
* Tablets: 100 mg as a single dose.
*Note: Dosing may vary based on formulation (e.g., immediate-release, delayed-release, extended-release). Always consult specific product labeling.*
## Pediatric Dosing
Diclofenac oral formulations are **not generally recommended** for use in pediatric patients due to lack of established efficacy and safety data. Some topical formulations may be used in adolescents.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate hepatic impairment may not require dose adjustment, but patients should be monitored. Severe hepatic impairment is a contraindication.
* **Renal Impairment:** Use with caution. Dose reduction may be considered in patients with severe renal impairment, though specific guidelines are lacking. NSAIDs can impair renal function.
* **Elderly:** Elderly patients are at increased risk of adverse effects. Consider a lower dose.
## Contraindications
* Known 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.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease (active).
* Severe hepatic impairment.
* Severe renal impairment.
* Heart failure (NYHA II-IV).
## Adverse Effects
* **Common:** Gastrointestinal upset (dyspepsia, nausea, diarrhea, constipation, abdominal pain), headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), serious gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic failure, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI.
## Monitoring
* **Baseline and periodic monitoring of renal function (BUN, creatinine).**
* **Baseline and periodic monitoring of liver function tests (ALT, AST).**
* **Monitor for signs and symptoms of GI bleeding, ulceration, and perforation.**
* **Monitor for signs and symptoms of cardiovascular events.**
* **Monitor blood pressure.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Avoid concomitant use with other NSAIDs.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution.
* Discontinue immediately if signs of hepatotoxicity or serious GI bleeding occur.
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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 professional resources before making any treatment decisions.*
