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# Diclofenac ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. ## Primary Indications * Inflammatory conditions (e.g., osteoarthritis, rheumatoid arthritis, ankylosing spondylitis) * Mild to moderate pain (e.g., musculoskeletal pain, dysmenorrhea) ## Adult Dosing * **Osteoarthritis:** 350 mg IM once or 75 mg BID, not to exceed 150 mg/day. * **Rheumatoid Arthritis/Ankylosing Spondylitis:** 50 mg TID, or 75 mg BID, not to exceed 225 mg/day. * **Pain/Dysmenorrhea:** 50 mg TID, not to exceed 150 mg/day. *Note: Specific dosing may vary based on the formulation (e.g., delayed-release, extended-release, topical) and local protocol.* ## Pediatric Dosing * **Rheumatoid Arthritis:** * 1 to 12 years: 1-3 mg/kg/day divided into 2-4 doses. Maximum 75 mg/day. * >12 years: Same as adult doses. *Note: Use in children should be carefully considered due to potential risks.* ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Monitor liver function. * **Renal Impairment:** Use with caution, especially in those with pre-existing renal disease. ## 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. * Active gastrointestinal bleeding or ulceration. * Severe hepatic or renal impairment. ## Adverse Effects * **Common:** Abdominal pain, dyspepsia, nausea, diarrhea, constipation, headache, dizziness. * **Serious:** * Cardiovascular thrombotic events (MI, stroke) * Gastrointestinal bleeding, ulceration, perforation * Hepatotoxicity (elevated liver enzymes, jaundice) * Renal toxicity (renal failure, interstitial nephritis) * Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) * Fluid retention and edema * Exacerbation of hypertension ## 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. * **ACE inhibitors, ARBs, Beta-blockers:** Diminished antihypertensive effect and increased risk of renal dysfunction. * **Lithium:** Increased lithium levels and toxicity. * **Methotrexate:** Increased methotrexate toxicity. ## Monitoring * Liver function tests (ALT, AST) periodically, especially with long-term use. * Renal function (creatinine, BUN) periodically. * Complete blood count (CBC) for signs of anemia or bleeding. * Blood pressure. * Signs and symptoms of GI bleeding or ulceration. ## 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 serious cardiovascular and gastrointestinal events, particularly at higher doses and with prolonged use. * Avoid concomitant use with other NSAIDs, including aspirin, unless specifically indicated and with caution. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details before making clinical decisions. Local guidelines and institutional protocols may supersede this information.