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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, inflammation, and stiffness.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and other musculoskeletal conditions.
* Acute pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum total daily dose: 225 mg.
* **Acute Pain:** 50 mg orally every 4 to 6 hours as needed. Maximum total daily dose: 200 mg for the first day, then 150 mg daily thereafter.
## Pediatric Dosing
* Dosing in pediatric patients is not well established for oral diclofenac. Use with caution and consider alternatives.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are routinely recommended, but liver function should be monitored closely.
* **Renal Impairment:** Use with caution. No specific dose adjustments are routinely recommended, but renal function should be monitored closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; anaphylaxis; Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **CYP2C9 inhibitors (e.g., fluconazole):** May increase diclofenac exposure.
## Monitoring
* **Baseline and periodic assessment of:**
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Complete blood count (CBC) for anemia or occult bleeding.
* Signs and symptoms of gastrointestinal bleeding or cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., proton pump inhibitors) for patients at increased risk of gastrointestinal complications.
* NSAIDs can mask signs of infection.
* Risk of cardiovascular events and gastrointestinal bleeding increases with duration of use and dose.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosing and safety information before initiating therapy.*
