Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2-3 doses (e.g., 50 mg BID or TID).
* **Acute Pain:** 50 mg TID initially, then 50 mg BID or TID as needed. Maximum initial dose 75 mg.
* **Primary Dysmenorrhea:** 50 mg TID as needed. Maximum initial dose 75 mg.
**Maximum Daily Dose:** Generally 150 mg/day for chronic conditions. Higher doses (up to 200 mg/day) may be used short-term for acute pain or dysmenorrhea under strict medical supervision.
## Pediatric Dosing
Established pediatric dosing is not widely available for oral diclofenac. Use in children is generally not recommended due to safety concerns and lack of clear efficacy data compared to other agents.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. In mild to moderate impairment, consider a lower starting dose and monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
* **Elderly:** Increased risk of adverse effects; consider lower doses and closer monitoring.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Inflammatory bowel disease (active).
* Heart failure (moderate to severe).
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal impairment, hepatic impairment, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects.
## Monitoring
* **GI:** Signs and symptoms of GI bleeding or ulceration (e.g., melena, hematemesis, abdominal pain).
* **Renal:** Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic:** Liver function tests (AST, ALT), especially in patients with pre-existing hepatic disease or those receiving long-term therapy.
* **Cardiovascular:** Blood pressure, signs/symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI events.
* NSAIDs carry a boxed warning for cardiovascular thrombotic events and serious GI bleeding.
* Be aware of potential for bronchospasm in patients with asthma, particularly those with aspirin-sensitive asthma.
***
*Disclaimer: This information is intended for clinical use and does not replace comprehensive drug compendia. Always verify current prescribing information with the most recent FDA-approved labeling or other authoritative sources before initiating or modifying therapy.*
