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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Management of acute pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg orally per day, divided into 3 doses (e.g., 50 mg TID). Doses can range from 100-200 mg daily.
* **Acute Pain:** Starting dose of 50 mg TID, followed by additional 50 mg doses as needed. Maximum daily dose: 150 mg.
* **Extended-Release Formulations:** Dosing varies by product, typically 100 mg once or twice daily.
## Pediatric Dosing
* Data is limited for oral diclofenac in pediatric patients for pain and inflammation. It is generally not recommended for routine use in children.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Moderate impairment may require dose reduction. Severe impairment is a contraindication.
* **Renal Impairment:** Use with caution, especially in patients with pre-existing renal disease. Monitor renal function.
## 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.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease.
* Severe hepatic or renal impairment.
* Heart failure.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic failure, hypersensitivity reactions, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **ACE Inhibitors, ARBs, Diuretics:** Decreased antihypertensive efficacy, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, especially gastrointestinal.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding and ulceration.
* Monitor renal function (BUN, creatinine) and electrolytes, especially in patients with risk factors.
* Monitor liver function tests (ALT, AST), especially with prolonged use or in patients with hepatic impairment.
* Monitor blood pressure.
* Assess pain and inflammation.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Avoid concurrent use with other NSAIDs.
* Patient education on recognizing signs of GI bleeding and cardiovascular events is crucial.
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*This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and patient-specific factors before making treatment decisions.*
