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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, or 75 mg orally twice daily.
* **Pain:** 25 mg orally every 6 to 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed.
* **Maximum Daily Dose:** 225 mg.
## Pediatric Dosing
* Dosing is not established for oral diclofenac in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but monitor renal function. Avoid in severe renal impairment.
## 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
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, GI bleeding, perforation, ulceration.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events (MI, stroke), hypertension.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus, fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and additive pharmacologic effects.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (melena, hematemesis).
* Monitor blood pressure.
* Monitor renal function (BUN, creatinine) especially in patients with risk factors.
* Monitor liver function tests (AST, ALT) especially with prolonged use or pre-existing liver disease.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI complications.
* Avoid concurrent use with other NSAIDs.
* Patients with pre-existing cardiovascular disease or risk factors should be carefully evaluated before initiating diclofenac.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete details and to verify dosage and safety information before making clinical decisions.*
