Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily in 2-3 divided doses. Typical doses range from 50-75 mg twice daily.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg every 8 hours as needed, starting with the onset of symptoms.
* **Maximum Daily Dose:** 200 mg per day.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients for most indications.
* **Juvenile Idiopathic Arthritis:** Dosing is established for delayed-release tablets and oral solution, but specific mg/kg recommendations vary by age and formulation and should be confirmed with current prescribing information or pediatric guidelines.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Increased risk of renal impairment and hyperkalemia.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (AST, ALT)
* Complete blood count (CBC)
* Signs and symptoms of gastrointestinal bleeding or ulceration
* Cardiovascular risk factors
## Clinical Pearls
* Lowest effective dose for the shortest duration needed to minimize risk.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Cardiovascular risk may increase with duration of use and higher doses.
* NSAIDs can mask signs of infection.
---
**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriateness of any medication and to review the most current prescribing information.
