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.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Acute pain management.
## 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 dose: 225 mg/day.
* Delayed-release: 75 mg to 150 mg daily, divided into 2-3 doses (e.g., 75 mg once or twice daily). Maximum dose: 225 mg/day.
* Extended-release: 100 mg once daily. Maximum dose: 100 mg/day.
* **Acute Pain:**
* Immediate-release: 50 mg every 8 hours as needed. Start with 50 mg initially, followed by 50 mg doses at 8-hour intervals. Maximum dose: 150 mg/day.
* Delayed-release: 50 mg to 75 mg at the start of treatment, followed by 50 mg every 8 hours as needed. Maximum dose: 150 mg/day.
* Extended-release: Not typically recommended for acute pain due to slower onset.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Dosing varies by age and weight. Consult specific pediatric guidelines or product information. A common starting point is 1-2 mg/kg/day divided into 2-4 doses, not to exceed the adult maximum dose.
* **Other Indications:** Generally not recommended in children under 14 years for other indications.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction. Severe impairment is a contraindication.
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in patients with significant renal impairment. Avoid use in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* History of GI bleeding or perforation related to previous NSAID use.
* Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, headache, dizziness, elevated liver enzymes.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic failure; severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis); exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of GI adverse effects and other toxicities.
## Monitoring
* Monitor for signs and symptoms of GI bleeding or ulceration.
* Assess for cardiovascular risk factors and signs of cardiovascular events.
* Regularly monitor renal function (serum creatinine, BUN) and liver function (transaminases), especially in patients with pre-existing renal or hepatic disease, or those on long-term therapy.
* Monitor blood pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Delayed-release and extended-release formulations should not be crushed or chewed.
* Caution in elderly patients, those with a history of GI disease, or cardiovascular disease.
* Consider co-administration of a proton pump inhibitor (PPI) for patients at increased risk of GI complications.
***
*This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information and consult with a healthcare provider before making any treatment decisions.*
