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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain, including post-operative pain and dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day, divided into 2 or 3 doses. Immediate-release: 50 mg three times daily, or 75 mg twice daily. Delayed-release: 75 mg twice daily. Extended-release: 100 mg once daily.
* **Mild to Moderate Pain/Dysmenorrhea:** 50 mg three times daily as needed. Maximum of 150 mg per day.
## Pediatric Dosing
* Generally not recommended for pediatric patients due to safety concerns and lack of established dosing. Some sources suggest limited use in specific inflammatory conditions, but consensus is lacking.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start at the lower end of the dosing range. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Avoid in severe renal impairment.
## Contraindications
* 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 perforation.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, fluid retention, edema.
* **Renal:** Renal insufficiency, acute kidney injury.
* **Hepatic:** Elevated liver enzymes, hepatic dysfunction, liver failure.
* **Other:** Dizziness, headache, rash, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) & Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors & ARBs:** Reduced antihypertensive effect and increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic effect and increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs:** Increased risk of GI bleeding.
## Monitoring
* **Renal Function:** Baseline and periodic monitoring of serum creatinine and BUN.
* **Hepatic Function:** Baseline and periodic monitoring of liver enzymes (ALT, AST).
* **Blood Pressure:** Monitor for hypertension.
* **Gastrointestinal Symptoms:** Assess for signs and symptoms of GI bleeding or ulceration.
* **Signs of Cardiovascular Events:** Educate patients on warning signs.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
* Be aware of the increased cardiovascular risk associated with NSAIDs, especially at higher doses and with prolonged use.
* Avoid concurrent use with other NSAIDs.
* Patients with a history of cardiovascular disease or risk factors should use diclofenac with caution, if at all.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the official drug product labeling and consult with a qualified healthcare provider for specific patient care decisions.*
