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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic and anti-inflammatory properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing the synthesis of prostaglandins.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg twice daily. Maximum daily dose: 225 mg.
* **Mild to Moderate Pain, Primary Dysmenorrhea:** Initial dose of 50 mg orally, followed by 50 mg every 6 to 8 hours as needed. Do not exceed 200 mg in 24 hours.
*Note: Dosing may vary based on specific product formulation (e.g., immediate-release vs. delayed-release) and local protocols.*
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most indications and is generally not recommended unless specifically indicated by a specialist. Limited data suggests use in juvenile rheumatoid arthritis, but requires careful consideration and monitoring.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. A dose reduction may be considered in patients with mild to moderate hepatic insufficiency. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Dose adjustment may be necessary in severe renal impairment, but specific guidelines are lacking.
## 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.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, headache, dizziness.
* **Serious:** Increased risk of serious cardiovascular thrombotic events (MI, stroke), serious gastrointestinal bleeding, ulceration, and perforation; renal failure; hepatic failure; anaphylactic reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **ACE inhibitors, ARBs, Diuretics:** May diminish antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **CYP2C9 Inhibitors (e.g., fluconazole):** May increase diclofenac plasma concentrations.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN).
* Liver function tests (ALT, AST).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose should be used for the shortest duration necessary.
* Consider risk factors for cardiovascular events and GI bleeding when prescribing.
* Avoid concomitant use with other NSAIDs.
* Caution in elderly patients due to increased risk of adverse effects.
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*Please verify the current prescribing information for the most up-to-date and complete details.*
