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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain
* Inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhea.
## Adult Dosing
* **Acute Pain:** 50 mg three times daily.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg two to three times daily, or 75 mg two times daily.
* **Primary Dysmenorrhea:** Initial dose of 50 mg, followed by 25-50 mg every 6-8 hours as needed.
* **Maximum Daily Dose:** 150 mg. Extended-release formulations have different dosing and maximums; consult specific product information.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Children 1 to 12 years: 1 to 3 mg/kg/day divided into 2 to 4 doses. Maximum 100 mg/day.
* **Other indications in pediatrics are generally not established or require specialist guidance.**
## Dose Adjustments
* **Hepatic Impairment:** Use with caution, may require dose reduction. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Children under 1 year of age.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, constipation, diarrhea, GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension.
* **Renal:** Renal impairment, fluid retention, edema.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Beta-Blockers:** Reduced antihypertensive efficacy, increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic efficacy, increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Cardiovascular Risk:** Assess baseline and monitor for new or worsening cardiovascular symptoms.
* **Renal Function:** Monitor serum creatinine and electrolytes, especially in patients with pre-existing renal disease or those at risk.
* **Liver Function:** Monitor LFTs periodically, especially with long-term use or in patients with liver disease.
* **Blood Pressure:** Monitor blood pressure regularly.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Be aware of the increased risk of cardiovascular events, particularly with prolonged use or higher doses.
* Consider gastroprotective agents (e.g., PPIs) for patients at increased risk of GI bleeding.
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*This information is intended for healthcare professionals. Please consult the official prescribing information and relevant guidelines for complete details and to verify current recommendations before prescribing.*
