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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Acute Pain:** 50 mg orally every 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum daily dose: 200 mg for the first day, then 100 mg daily thereafter.
* **Extended-release formulations:** Typically 100 mg once daily.
Dosing may vary based on specific product formulation and local protocols.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1 mg/kg/day orally divided into 2 to 4 doses. Maximum daily dose: 75 mg. Not recommended for children under 1 year of age.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and the lowest effective dose should be used.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or perforation.
* History of GI bleeding or perforation related to prior NSAID use.
* Heart failure (NYHA Class II-IV).
* Last trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, flatulence, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI ulceration, bleeding, perforation, hepatotoxicity, nephrotoxicity, hypersensitivity reactions, anaphylaxis, severe skin reactions (e.g., Stevens-Johnson syndrome).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs and Salicylates:** Increased risk of GI toxicity and additive effects.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **SSRIs/SNRIs:** Increased risk of bleeding.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Blood pressure.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize GI and cardiovascular risks.
* Consider co-administration with a proton pump inhibitor (PPI) for patients at increased risk of GI events.
* Avoid concurrent use with other NSAIDs.
* Discontinue use immediately if signs of hepatotoxicity, nephrotoxicity, or serious cardiovascular events occur.
* Patients with dehydration, heart failure, or hepatic cirrhosis may be at higher risk for renal toxicity.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete and up-to-date details regarding drug use, dosing, contraindications, interactions, and adverse effects.*
