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# Diclofenac (Oral) ## Overview Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. ## Primary Indications * Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis. * Acute pain. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg/day divided into 2 or 3 doses (e.g., 50 mg twice daily or 75 mg twice daily). Maximum recommended daily dose is 225 mg. * **Acute Pain:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Maximum daily dose is 150 mg. ## Pediatric Dosing * Information on oral diclofenac pediatric dosing is limited and not well-established for all indications. Specific pediatric dosing should be determined by a healthcare provider based on the indication and patient's weight. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but the lowest effective dose should be used. Avoid in severe hepatic impairment. * **Renal Impairment:** Use with caution. Patients with mild to moderate renal impairment may require a dose reduction. Avoid in severe renal impairment. ## Contraindications * Hypersensitivity to diclofenac, aspirin, or other NSAIDs. * History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Concomitant use with other NSAIDs. ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, dyspepsia), abdominal pain, headache, dizziness, rash, edema. * **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, perforation, hepatic enzyme elevations, renal impairment, anaphylaxis. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Other NSAIDs (including aspirin):** Increased risk of GI toxicity and other adverse effects. * **ACE Inhibitors/ARBs:** May reduce antihypertensive effect and increase risk of renal impairment. * **Diuretics:** May reduce diuretic effect and increase risk of renal impairment. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased risk of methotrexate toxicity. * **SSRIs/SNRIs:** Increased risk of bleeding. ## Monitoring * Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis). * Monitor blood pressure, especially in patients with hypertension. * Monitor renal function (BUN, creatinine) and liver function (LFTs) periodically, particularly in patients with pre-existing renal or hepatic disease. * Assess for signs of cardiovascular events. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse effects. * Administer with food or milk to reduce gastrointestinal upset. * Consider gastroprotection (e.g., PPI) in patients at increased risk for GI events. * Be aware of the increased risk of cardiovascular events and GI bleeding associated with NSAID use. *** *This information is intended for clinical use and does not replace the need to consult the most current prescribing information and institutional protocols.*