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# Diclofenac Tablet
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce inflammation and pain. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg per day, divided into 2-4 doses. Maximum daily dose is 200 mg.
* **Mild to moderate pain and Primary Dysmenorrhea:** 50 mg three times daily as needed. Alternatively, an initial dose of 100 mg followed by 50 mg doses if necessary. Maximum daily dose is 150 mg for short-term use.
Immediate-release formulations are typically dosed every 6-8 hours. Delayed-release and extended-release formulations have different dosing frequencies.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg per day in divided doses. Maximum daily dose is 200 mg. Dosing is generally not recommended for children under 1 year of age.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Starting dose may need to be reduced. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Avoid in severe renal impairment.
* **Elderly:** Increased risk of adverse events; consider lower doses and close monitoring.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Pregnancy (third trimester).
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, dyspepsia), abdominal pain, dizziness, headache, rash.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), serious gastrointestinal bleeding/perforation, hepatotoxicity, renal toxicity, fluid retention and edema, exacerbation of hypertension, hypersensitivity reactions, Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs and SNRIs:** Increased risk of bleeding.
* **ACE inhibitors and ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Liver function tests (ALT, AST) periodically, especially with long-term use or in patients with pre-existing liver disease.
* Renal function tests (creatinine, BUN) periodically, especially in patients with renal impairment, heart failure, or receiving concomitant nephrotoxic agents.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for gastrointestinal complications.
* Avoid concomitant use with other NSAIDs.
* Patients with a history of cardiovascular disease or risk factors should use diclofenac with caution.
* Discontinue diclofenac at the first sign of skin rash or any other sign of hypersensitivity.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant literature for complete details before making any clinical decisions.*
