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# Diclofenac Oral Tablet
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain management (mild to moderate)
* Menstrual pain (dysmenorrhea)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Immediate-release: 150 mg daily, divided into 2-3 doses. Maximum 225 mg daily.
* Delayed-release: 75 mg twice daily, or 100 mg once daily. Maximum 225 mg daily.
* Extended-release: 100 mg once daily. Maximum 100 mg daily.
* **Pain, Dysmenorrhea:**
* Immediate-release: 50 mg three times daily as needed. Alternatively, an initial 100 mg dose followed by 50 mg doses if needed. Maximum 150 mg daily.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for oral formulations and is typically based on weight and indication, requiring careful consideration and expert consultation.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses.
* **Renal Impairment:** Use with caution. Monitor renal function. May require dose reduction.
## 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:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatotoxicity, renal toxicity, hypersensitivity reactions, exacerbation of hypertension, fluid retention.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Liver function tests (LFTs) periodically.
* Renal function tests (serum creatinine, BUN) periodically, especially in patients with risk factors.
* Blood pressure.
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk of GI complications.
* Educate patients on signs of GI bleeding, cardiovascular events, and hepatotoxicity.
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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 relevant literature for complete drug details and to ensure patient safety. Local protocols may dictate specific dosing regimens.
