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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Acute pain
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Dysmenorrhea
## Adult Dosing
* **Acute Pain:** 50 mg three times daily as needed.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg two to three times daily or 75 mg twice daily.
* **Dysmenorrhea:** 50 mg three times daily as needed.
* **Maximum Daily Dose:** 200 mg.
## Pediatric Dosing
* **Ages 1-12 years:** 0.5-2 mg/kg/day in 2-3 divided doses for analgesia and anti-inflammatory effects.
* **Ages 12 years and older:** Same as adult dosing.
* **Maximum Daily Dose:** 200 mg.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; consider lower doses.
* **Renal Impairment:** Use with caution; monitor renal function. Avoid in severe renal impairment if possible.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active gastrointestinal bleeding or perforation.
* History of GI bleeding or perforation with prior NSAID use.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, dyspepsia, constipation, flatulence.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI perforation, ulceration, bleeding, hepatotoxicity, renal toxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics:** Increased risk of renal impairment and hyperkalemia.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* **GI:** Assess for signs and symptoms of GI bleeding or ulceration.
* **Renal:** Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease, dehydration, or those taking concomitant nephrotoxic agents.
* **Hepatic:** Monitor liver function tests (ALT, AST) if symptoms develop or with long-term use.
* **Cardiovascular:** Assess for signs and symptoms of cardiovascular events.
## 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.
* Risk of cardiovascular thrombotic events increases with dose and duration of use.
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and consider individual patient factors.
