Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and joint stiffness caused by arthritis.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* **Immediate-release:** 150 mg daily divided into 2-3 doses (e.g., 50 mg twice or three times daily). Maximum 225 mg/day.
* **Delayed-release:** 75 mg twice daily (150 mg/day). Maximum 225 mg/day.
* **Extended-release:** 100 mg once daily. Maximum 100 mg/day.
* **Pain, Primary Dysmenorrhea:**
* **Immediate-release:** 50 mg three times daily as needed. For severe pain, initial dose of 100 mg followed by 50 mg doses. Maximum 200 mg/day.
* **Delayed-release:** 50 mg twice daily. Maximum 150 mg/day.
## Pediatric Dosing
Dosing in children is not well-established and generally not recommended due to increased risk of adverse effects. Use is typically reserved for specific situations under specialist guidance.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start with lower doses. Diclofenac is contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Diclofenac is contraindicated in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of 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 ulceration.
* Inflammatory bowel disease (active).
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal perforation/bleeding, renal toxicity, hepatotoxicity, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), fluid retention/edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, especially GI toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Baseline and periodic:** Renal function (BUN, creatinine), liver function (ALT, AST), complete blood count (CBC) to assess for anemia or thrombocytopenia.
* **Regularly:** Blood pressure, signs and symptoms of GI bleeding (e.g., melena, hematemesis), signs and symptoms of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious cardiovascular and gastrointestinal adverse events.
* Consider concomitant gastroprotection (e.g., proton pump inhibitor) in patients with increased risk factors for GI events.
* Monitor for signs of fluid retention and edema, especially in patients with heart failure or hypertension.
* Patients with a history of asthma may be at increased risk of bronchospasm.
**Disclaimer:** This information is intended for clinical use and does not substitute for comprehensive drug information resources. Always consult the most current prescribing information and institutional protocols before making therapeutic decisions.
