Please check your internet connection and try again.
# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Management of mild to moderate pain.
## Adult Dosing
* **Osteoarthritis:** 350 mg orally once daily (extended-release formulation).
* **Rheumatoid Arthritis/Ankylosing Spondylitis:** 50 mg orally 2-3 times daily or 75 mg orally twice daily.
* **Pain:** 50 mg orally every 4-6 hours as needed.
**Maximum Daily Dose:** 150 mg for immediate-release formulations, 200 mg for extended-release formulations.
## Pediatric Dosing
* **Pain/Inflammation (Rheumatoid Arthritis):**
* 1-12 years: 1-3 mg/kg/day divided into 2-4 doses.
* Maximum daily dose: 4 mg/kg/day.
* Dosing should be individualized based on clinical response and tolerability. Specific tablet strengths for pediatric dosing may vary.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; consider dose reduction. Not recommended in severe hepatic impairment.
* **Renal Impairment:** Use with caution; consider dose reduction. Not recommended in severe renal impairment.
## 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.
* Concurrent use with other NSAIDs, including aspirin (unless low-dose aspirin for cardioprotection).
* Severe heart failure.
## Adverse Effects
* **Common:** Gastrointestinal distress (nausea, vomiting, diarrhea, abdominal pain), headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding/perforation, renal impairment, hepatic injury, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors/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 risk of methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
## Monitoring
* **Renal function:** Baseline and periodically, especially in patients with risk factors for renal impairment.
* **Hepatic function:** Baseline and periodically, especially in patients with risk factors for hepatic impairment.
* **Blood pressure:** Monitor for hypertension.
* **Signs of gastrointestinal bleeding:** Stool guaiac, epigastric pain, melena.
* **Signs of cardiovascular events:** Chest pain, shortness of breath.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* NSAID use, including diclofenac, may increase the risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
* NSAID use carries a significant risk of gastrointestinal perforation, ulceration, and bleeding.
* Extended-release formulations should not be crushed or chewed.
***
*Disclaimer: This information is intended for clinical decision support and does not replace the need for physician judgment and verification of current prescribing information, including full prescribing details, contraindications, warnings, precautions, and adverse reactions, from the official product labeling or other authoritative sources.*
