Please check your internet connection and try again.
# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain (e.g., post-operative, musculoskeletal)
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily.
* **Mild to moderate pain and Dysmenorrhea:** 50 mg orally three times daily, or 75 mg orally twice daily.
* **Acute pain:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed.
* **Maximum Daily Dose:** 150 mg for chronic conditions; 200 mg for acute pain.
Dosing may vary based on specific product formulation (e.g., delayed-release, extended-release) and local protocols.
## Pediatric Dosing
Diclofenac is generally not recommended for use in pediatric patients for most indications due to safety concerns and lack of established dosing. Some specific formulations and indications may have pediatric dosing available, which would be guideline-dependent.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require lower doses.
* **Renal Impairment:** Use with caution. Monitor renal function. May require dose reduction.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease (active).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, elevated liver enzymes, headache, dizziness.
* **Serious:**
* Cardiovascular: Increased risk of myocardial infarction, stroke, and heart failure.
* Gastrointestinal: Bleeding, ulceration, perforation.
* Renal: Renal impairment, interstitial nephritis, papillary necrosis.
* Hepatic: Hepatotoxicity, liver failure.
* Hypersensitivity reactions: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, apixaban):** Increased risk of bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal toxicity and renal impairment.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors and ARBs:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic effect, increased risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
## Monitoring
* **Baseline and periodic renal function tests (BUN, creatinine).**
* **Baseline and periodic liver function tests (ALT, AST).**
* **Monitor for signs and symptoms of gastrointestinal bleeding (melena, hematemesis).**
* **Monitor for signs and symptoms of cardiovascular events.**
* **Monitor for signs and symptoms of hypersensitivity reactions.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI events.
* NSAIDs can mask signs of infection.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution.
* Advise patients to report any new or worsening symptoms, especially those related to GI distress, bleeding, or cardiovascular events.
---
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Dosing and indications may vary based on specific product formulations, patient factors, and local institutional protocols.
