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# Diclofenac
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis:** 350 mg extended-release (ER) capsule once daily.
* **Rheumatoid Arthritis, Ankylosing Spondylitis:** 750 mg ER capsule once daily or 375 mg ER capsule twice daily.
* **Acute Pain:** 500 mg ER capsule once daily.
* **Primary Dysmenorrhea:** 500 mg ER capsule once daily.
* **Maximum Dose:** The maximum recommended daily dose for ER capsules is 1000 mg.
## Pediatric Dosing
Diclofenac ER capsules are not recommended for use in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is recommended, but patients with severe hepatic impairment should be closely monitored.
* **Renal Impairment:** Use with caution. No specific dose adjustment is recommended, but patients with significant renal impairment should be closely monitored.
## Contraindications
* Known 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
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, flatulence, GI bleeding, perforation, ulceration.
* **Cardiovascular:** Hypertension, edema, increased risk of myocardial infarction and stroke.
* **Renal:** Renal impairment, acute renal failure.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache.
## Key Drug Interactions
* **ACE Inhibitors, Angiotensin Receptor Blockers (ARBs):** Increased risk of renal impairment.
* **Aspirin:** Increased risk of GI bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Warfarin and other anticoagulants:** Increased risk of bleeding.
## Monitoring
* Baseline and periodic monitoring of renal function (serum creatinine, BUN).
* Baseline and periodic monitoring of liver function (ALT, AST).
* Blood pressure monitoring.
* Signs and symptoms of GI bleeding or ulceration.
## Clinical Pearls
* Diclofenac ER capsules should be swallowed whole and not crushed or chewed.
* To minimize the risk of GI adverse events, use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., proton pump inhibitors) in patients at increased risk for GI complications.
* Patients with pre-existing cardiovascular disease or risk factors should be carefully assessed before initiating diclofenac.
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*This information is intended for healthcare professionals and does not substitute for consulting the official prescribing information for diclofenac, which may contain more detailed safety and efficacy data. Always verify current prescribing information before use.*
