Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## 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 or 3 doses (e.g., 50 mg twice daily or 75 mg twice daily for extended-release).
* **Acute Pain:** 25 mg every 6 to 8 hours as needed. Do not exceed 75 mg in 24 hours.
* **Primary Dysmenorrhea:** 50 mg at the onset of symptoms, followed by 25 mg every 6 to 8 hours as needed. Do not exceed 100 mg on the first day, and 75 mg on subsequent days.
* **Maximum Daily Dose:** 150 mg for chronic conditions. For acute pain or dysmenorrhea, the maximum depends on the specific indication and duration.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 2 mg/kg/day divided into 2 to 4 doses. Do not exceed 75 mg daily.
* Dosing for other indications in children is generally not established or recommended.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start at the lower end of the dosing range. Monitor liver function.
* **Renal Impairment:** Use with caution. Patients with severe renal impairment may require dose reduction. Monitor renal function.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or other 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, dyspepsia, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal perforation and bleeding, renal failure, hepatotoxicity, severe skin reactions (e.g., Stevens-Johnson syndrome), exacerbation of hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Baseline:** Complete blood count (CBC), renal function (BUN, creatinine), liver function tests (AST, ALT).
* **During Therapy:** Periodic CBC, renal function, liver function tests. Monitor for signs and symptoms of gastrointestinal bleeding, cardiovascular events, and hypersensitivity reactions. Blood pressure monitoring.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of gastrointestinal complications.
* NSAIDs carry a risk of cardiovascular events, even with short-term use.
* Avoid concomitant use with other NSAIDs.
* Patients with pre-existing renal disease, heart failure, or liver disease are at increased risk of adverse effects.
***
*This information is intended for healthcare professionals. Please consult current prescribing information for complete details and to verify applicability to your patient.*
