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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic and anti-inflammatory properties. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces the synthesis of prostaglandins.
## Primary Indications
* Pain associated with musculoskeletal disorders (e.g., osteoarthritis, rheumatoid arthritis, ankylosing spondylitis)
* Mild to moderate pain (e.g., dysmenorrhea, post-operative pain)
## Adult Dosing
* **Osteoarthritis:** 350 mg/day (delayed-release) or 75-150 mg/day (extended-release) divided into 2-3 doses.
* **Rheumatoid Arthritis/Ankylosing Spondylitis:** 150 mg/day divided into 3 doses.
* **Acute Pain/Dysmenorrhea:** 50 mg three times daily as needed.
* **Maximum Daily Dose:** 150 mg for immediate-release formulations; 200 mg for extended-release formulations.
* *Note: Dosing for specific formulations (e.g., delayed-release vs. extended-release) varies; consult product labeling.*
## Pediatric Dosing
Dosing is not well-established for children. Use with caution and at the lowest effective dose if deemed necessary, typically for specific inflammatory conditions. Consult pediatric-specific resources.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in patients with mild to moderate liver dysfunction. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function, especially in elderly patients or those with pre-existing renal disease. Dose reduction may be needed. Avoid in severe renal impairment.
* **Elderly:** Increased risk of adverse effects; use the lowest effective dose.
## Contraindications
* 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding/ulceration/perforation, renal failure, hepatic failure, anaphylactic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration/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 toxicity.
## Monitoring
* **Renal function:** Baseline and periodically, especially in elderly or renally compromised patients.
* **Hepatic function:** Baseline and periodically, especially in patients with pre-existing liver disease.
* **Signs and symptoms of GI bleeding/perforation:** Regularly, especially in high-risk patients.
* **Blood pressure:** Monitor for possible increases.
* **Signs and symptoms of cardiovascular events:** Monitor for chest pain, shortness of breath, weakness, slurring of speech.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk of GI complications.
* NSAIDs, including diclofenac, carry a risk of serious cardiovascular thrombotic events.
* NSAIDs can cause serious skin reactions. Discontinue at the first sign of rash or other signs of hypersensitivity.
* Delayed-release formulations are not intended for immediate symptom relief.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace independent clinical judgment. Always verify current prescribing information and consult with the most up-to-date resources before making any treatment decisions.
