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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Mild to moderate pain
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Dysmenorrhea
## Adult Dosing
* **Pain:** 50 mg three times daily. Alternatively, 75 mg twice daily. Maximum daily dose: 225 mg.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg two to three times daily or 75 mg twice daily. Maximum daily dose: 225 mg.
* **Dysmenorrhea:** Initial dose 50 mg, followed by 25-50 mg every 6-8 hours as needed. Total daily dose should not exceed 200 mg.
Immediate-release formulations are typically taken every 6-8 hours. Delayed-release or extended-release formulations have different dosing schedules.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be based on clinical judgment and expert consultation.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is recommended for mild to moderate impairment, but monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. No specific dose adjustment is recommended for mild to moderate impairment, but monitor renal function closely. Avoid in severe renal impairment.
## 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, elevated liver enzymes, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events (myocardial infarction, stroke), renal toxicity, hepatotoxicity, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal bleeding and renal adverse effects.
* **ACE inhibitors/ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Serum creatinine, BUN.
* **Liver function:** ALT, AST.
* **Gastrointestinal symptoms:** Assess for signs of bleeding or ulceration.
* **Cardiovascular risk factors.**
* **Blood pressure.**
## Clinical Pearls
* Lowest effective dose for the shortest duration should be used to minimize risk.
* Administer with food or milk to reduce gastrointestinal upset.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk of GI complications.
* Monitor for signs and symptoms of cardiovascular events and renal or hepatic toxicity.
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This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information and consult with a healthcare provider for specific patient care decisions.
