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# Diclofenac Tablet
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Pain associated with rheumatoid arthritis
* Pain associated with ankylosing spondylitis
* Acute pain (e.g., post-operative, musculoskeletal)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Immediate-release (IR): 150 mg daily divided into 2-3 doses (e.g., 50 mg BID or TID). Maximum: 225 mg daily.
* Delayed-release (DR) or Extended-release (ER): 75-100 mg once daily or divided BID. Maximum: 100 mg daily for ER.
* **Acute Pain:**
* IR: 50 mg every 8 hours as needed.
* Maximum: 150 mg daily.
* **Primary Dysmenorrhea:**
* IR: 50 mg TID as needed.
* Maximum: 150 mg daily.
Dose and frequency should be individualized to the lowest effective dose.
## Pediatric Dosing
Diclofenac is generally not recommended for pediatric patients due to limited safety and efficacy data for most oral formulations. Topical diclofenac has specific pediatric dosing for certain indications.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Initiate at a lower dose. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, edema.
* **Renal:** Renal insufficiency, acute renal failure, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Other:** Dizziness, headache, rash, tinnitus, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** Increased risk of GI ulceration and bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced diuretic efficacy, increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **ACE inhibitors/ARBs:** Increased risk of renal impairment.
## Monitoring
* **Baseline and periodic monitoring:** Renal function (serum creatinine, BUN), liver function tests (AST, ALT), complete blood count (CBC) for signs of anemia or occult bleeding.
* **Cardiovascular risk assessment.**
* **Signs and symptoms of GI bleeding and cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Extended-release formulations should not be crushed or chewed.
* Caution in patients with pre-existing cardiovascular disease, hypertension, or risk factors for cardiovascular events.
* Risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke can occur anytime during treatment and may be increased with duration of use.
* NSAIDs can cause serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines at any time during treatment.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details before making any treatment decisions.*
