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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## 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:** 150 mg daily divided into 2 or 3 doses (e.g., 50 mg BID or TID) or 75 mg once daily extended-release formulation.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Maximum Daily Dose:** 200 mg.
## Pediatric Dosing
* Not established for oral formulations.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; consider a lower starting dose and monitor.
* **Renal Impairment:** Use with caution; monitor renal function.
## 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:** Gastrointestinal upset, nausea, abdominal pain, dyspepsia, diarrhea, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events, myocardial infarction, stroke, gastrointestinal bleeding, ulceration, perforation, renal failure, hepatotoxicity, hypersensitivity reactions, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI adverse effects and potential for additive analgesic effects.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations and toxicity.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Complete blood count (CBC) for signs of anemia or occult bleeding.
* Signs and symptoms of GI bleeding or ulceration.
* Blood pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Extended-release formulations should not be crushed or chewed.
* Be aware of increased cardiovascular and GI risks, especially with prolonged use or in high-risk patients.
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**Disclaimer:** This information is for educational purposes only and does not substitute professional medical advice. Always consult the most current prescribing information and guidelines for definitive patient care decisions.
