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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Pain associated with rheumatoid arthritis
* Pain associated with ankylosing spondylitis
* Mild to moderate pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily, or 75 mg twice daily. Maximum dose: 225 mg/day.
* **Mild to Moderate Pain:** 50 mg every 4 to 6 hours as needed. Maximum dose: 150 mg/day.
* *Note: Specific dosing may depend on local protocols and product formulation (e.g., delayed-release vs. immediate-release).*
## Pediatric Dosing
* Dosing in pediatric patients is not well-established for oral diclofenac for most indications. Safety and efficacy have not been confirmed.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start with a lower dose.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
## 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:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and renal toxicity.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Pain and inflammation assessment.
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Blood pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risk.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI events.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
