Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Enteric-coated or delayed-release tablets: 350 mg orally once daily or 175 mg orally twice daily.
* Extended-release tablets: 100 mg orally once daily.
* **Pain, Primary Dysmenorrhea:**
* Immediate-release tablets: 25 mg orally every 4 to 6 hours as needed, or 50 mg orally every 6 to 8 hours as needed.
* **Maximum Daily Dose:** 150 mg for immediate-release products, 200 mg for extended-release products. Do not exceed 75 mg per dose for immediate-release.
## Pediatric Dosing
* **Pain and Inflammation associated with Juvenile Idiopathic Arthritis:**
* 1 to 15 years: 1 to 3 mg/kg/day in divided doses every 8 hours. Maximum daily dose is 75 mg.
* Some sources recommend doses up to 2-3 mg/kg/day for children 2-15 years. Consult specific pediatric guidelines.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses.
* **Renal Impairment:** Use with caution. Consider lower doses, especially in severe 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:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, elevated liver enzymes, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hypertension, renal failure, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Baseline and periodic assessment of renal function (creatinine, BUN).
* Baseline and periodic assessment of liver function tests (ALT, AST).
* Blood pressure.
* Signs and symptoms of gastrointestinal bleeding.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Lowest effective dose for the shortest duration necessary should be used to minimize risk.
* Take with food or milk to reduce gastrointestinal upset.
* Be aware of the increased risk of cardiovascular and gastrointestinal events, particularly with long-term use or higher doses.
* Avoid concomitant use with other NSAIDs.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
