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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Short-term treatment of mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily or 75 mg twice daily.
* **Short-term pain:** 50 mg every 4 to 6 hours as needed.
* **Maximum Daily Dose:** 200 mg.
## Pediatric Dosing
Dosing has not been established in pediatric patients for most oral formulations. Extended-release formulations are not recommended for children.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; may be necessary to reduce dose.
* **Renal Impairment:** Use with caution. Patients with mild to moderate renal impairment may not require dose adjustments, but close monitoring is recommended. 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.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding/ulceration/perforation, hepatotoxicity, renal toxicity, hypersensitivity reactions, Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Complete blood count (CBC) for anemia or signs of GI bleeding.
* Blood pressure.
* Signs and symptoms of GI bleeding or cardiovascular events.
## Clinical Pearls
* Lowest effective dose for shortest duration.
* Administer with food or milk to minimize GI upset.
* Monitor for signs of cardiovascular risk, especially with prolonged use or in patients with risk factors.
* Discontinue immediately if signs of liver injury or serious adverse events occur.
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**Disclaimer:** This information is intended for clinical use and does not replace professional medical judgment. Always consult the most current prescribing information and institutional protocols for definitive guidance.
