Please check your internet connection and try again.
# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* 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. Maximum recommended daily dose is 200 mg.
* **Acute Pain:** 50 mg every 8 hours as needed. Maximum recommended daily dose is 150 mg for the first day, then 100 mg daily thereafter.
* **Primary Dysmenorrhea:** 50 mg three times daily as needed. Maximum recommended daily dose is 200 mg.
* **Delayed-release formulations:** May require higher initial doses and different dosing frequencies based on specific product labeling.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-12 years: 1-3 mg/kg/day in divided doses. Doses exceeding 3 mg/kg/day are not recommended.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but monitor closely. Severe impairment is a contraindication.
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but monitor closely. Severe impairment may warrant dose reduction or avoidance.
## 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.
* Active peptic ulceration or GI bleeding.
* Severe hepatic or renal impairment.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hepatotoxicity, renal toxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and potential for toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Baseline and periodic monitoring.
* **GI symptoms:** Monitor for signs of bleeding or ulceration.
* **Blood pressure:** Especially in patients with hypertension.
* **Signs of cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Be aware of the increased risk of cardiovascular events and serious GI events with NSAID use.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotection (e.g., proton pump inhibitor) in patients at high risk for GI complications.
This information is intended for healthcare professionals. Please refer to the most current prescribing information and consult relevant guidelines for complete details and to verify current prescribing information.
