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# Diclofenac Oral
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain management
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day, divided into 2 or 3 doses. A starting dose of 50 mg three times daily is common.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg three times daily as needed.
* **Maximum Daily Dose:** 200 mg per day.
## Pediatric Dosing
Limited data available. Specific dosing should be guided by pediatric rheumatology protocols or expert consultation.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Reduce dose if clinically indicated.
* **Renal Impairment:** Use with caution. Monitor renal function.
## Contraindications
* Known 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:** Gastrointestinal upset (dyspepsia, nausea, abdominal pain), diarrhea, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal impairment, hepatic failure, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE Inhibitors/ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (LFTs).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration should be used to minimize cardiovascular and GI risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Discontinue immediately if signs of hepatic or renal dysfunction, or serious cardiovascular events occur.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and professional guidelines before making any treatment decisions.*
