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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2-3 doses (e.g., 50 mg TID or 75 mg BID).
* **Acute Pain:** 50 mg TID as needed.
* **Primary Dysmenorrhea:** Initial dose of 50 mg, followed by 25-50 mg every 6-8 hours as needed.
* **Maximum Daily Dose:** Generally 200 mg.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day divided into 2-4 doses. Maximum daily dose: 200 mg.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment, but start at the lower end of the dosing range. Monitor for adverse effects.
* **Renal Impairment:** Use with caution. No specific dose adjustment, but patients with severe renal impairment may require dose reduction. Monitor for adverse effects.
## 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 (GI) bleeding or perforation.
## Adverse Effects
Common: Dyspepsia, nausea, abdominal pain, diarrhea, constipation, headache, dizziness.
Serious: Cardiovascular thrombotic events (MI, stroke), GI bleeding/perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, rivaroxaban):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI symptoms:** Monitor for signs of bleeding or ulceration.
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic function:** Monitor LFTs, especially in patients with hepatic impairment or those on long-term therapy.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of cardiovascular events.**
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk for GI complications.
* Discontinue if any signs of severe adverse reactions (e.g., rash, GI bleeding, jaundice) occur.
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*This information is intended for healthcare professionals. Please verify current prescribing information with the official drug product labeling or reliable drug information resources before making clinical decisions.*
