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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Mild to moderate pain (e.g., dysmenorrhea, postoperative pain)
## Adult Dosing
* **Osteoarthritis:** 350 mg (delayed-release) once daily.
* **Rheumatoid Arthritis:** 50 mg three times daily or 75 mg twice daily.
* **Ankylosing Spondylitis:** 25 mg four times daily or 50 mg twice daily.
* **Acute Pain/Dysmenorrhea:** 500 mg initially, then 500 mg every 8 hours as needed (delayed-release).
* **Maximum Daily Dose:** Generally 150 mg (immediate-release) or 200 mg (delayed-release) per day. Higher doses may be used under specific circumstances but increase risk.
## Pediatric Dosing
* **Pain and Inflammation (e.g., Juvenile Idiopathic Arthritis):** 1 mg/kg/day divided into 2-4 doses. Maximum dose not established by FDA for oral diclofenac, but generally limited to adult maximums. Safety and efficacy in children under 1 year have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment, but monitor renal function closely.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment, but monitor liver function closely. Start at the lower end of the dosage range.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding/perforation, renal failure, hepatic failure, hypertension, edema, anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum concentrations.
## Monitoring
* **Baseline and periodic:** Renal function (SCr, BUN), liver function tests (ALT, AST), complete blood count (CBC).
* **Patients with cardiovascular risk factors:** Blood pressure, signs of fluid retention.
* **Patients with GI history:** Signs and symptoms of GI bleeding.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Delayed-release formulations can reduce GI upset but may have a slower onset of action.
* Avoid concurrent use with other NSAIDs or aspirin unless specifically indicated.
* Consider gastroprotection (e.g., PPI) in patients with increased risk of GI events.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify recommendations.*
