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# Diclofenac (Oral) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, inflammation, and stiffness. ## Primary Indications * Inflammatory conditions such as rheumatoid arthritis, osteoarthritis. * Pain relief, including acute musculoskeletal pain, dysmenorrhea. ## Adult Dosing * **Osteoarthritis:** 350 mg orally once daily (extended-release formulation). * **Rheumatoid Arthritis:** 50 mg orally three times daily or 75 mg orally twice daily. * **Acute Pain/Dysmenorrhea:** 500 mg orally once on the first day, followed by 250 mg orally on subsequent days (delayed-release formulation). Alternatively, 50 mg orally three times daily as needed. * **Maximum Daily Dose:** Typically 150 mg for immediate-release or 200 mg for extended-release formulations for chronic use, though some protocols may allow higher for acute pain. Consult specific product labeling and local protocol. ## Pediatric Dosing * **Juvenile Idiopathic Arthritis:** 2-3 mg/kg/day divided into 2-3 doses. Do not exceed adult maximum doses. Use in children under 1 year is generally not recommended due to potential toxicity. ## Dose Adjustments * **Hepatic Impairment:** Use with caution; dose reduction may be necessary in mild to moderate impairment. Avoid in severe hepatic impairment. * **Renal Impairment:** Use with caution; dose reduction may be necessary in mild to moderate impairment. 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. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), headache, dizziness, rash. * **Serious:** Increased risk of serious cardiovascular thrombotic events (myocardial infarction, stroke), serious gastrointestinal bleeding, ulceration, and perforation. Renal toxicity, hepatic toxicity, fluid retention, hypertension. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **ACE inhibitors, ARBs, Diuretics:** Decreased antihypertensive effect and increased risk of renal impairment. * **Lithium, Methotrexate:** Increased serum levels and toxicity. ## Monitoring * **Renal function:** Especially in patients with pre-existing renal disease or those taking diuretics/ACE inhibitors. * **Liver function:** Baseline and periodically during chronic therapy. * **Blood pressure:** Regular monitoring. * **Signs and symptoms of gastrointestinal bleeding.** * **Signs and symptoms of cardiovascular events.** ## Clinical Pearls * Consider the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce gastrointestinal upset. * Extended-release formulations should not be crushed or chewed. * Be aware of the increased risk of cardiovascular events and gastrointestinal bleeding, particularly with higher doses and prolonged use. **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and local protocols before administering any medication.