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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Pain associated with osteoarthritis
* Pain associated with rheumatoid arthritis
* Pain associated with ankylosing spondylitis
* Acute pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily, or 75 mg twice daily.
* **Acute Pain:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Alternatively, 100 mg once, followed by 50 mg every 8 hours as needed.
* **Maximum Daily Dose:** 200 mg.
## Pediatric Dosing
* Not established for oral formulations in children.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start with a lower dose.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
## 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, flatulence, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hypertension, renal failure, hepatic failure, anaphylaxis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** 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
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor blood pressure, especially in patients with hypertension.
* Monitor renal function (serum creatinine, BUN) and electrolytes.
* Monitor liver function tests (ALT, AST).
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI events.
* Advise patients to report any new or worsening cardiovascular symptoms immediately.
* Avoid concomitant use with other NSAIDs.
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*This information is for educational purposes and does not substitute for current prescribing information. Always consult the most recent drug monograph and institutional protocols.*
