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# Diclofenac Tablets ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce inflammation and pain. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins. ## Primary Indications * Pain and inflammation associated with osteoarthritis * Pain and inflammation associated with rheumatoid arthritis * Ankylosing spondylitis * Acute pain (mild to moderate) ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** * Immediate-release (IR) tablets: 150 mg daily, divided into 2 or 3 doses. Typical dose is 50 mg twice daily or 75 mg twice daily. * Delayed-release (DR) tablets: 75 mg twice daily. * Extended-release (ER) tablets: 100 mg once daily. * **Acute Pain:** * 25 mg every 6 to 8 hours as needed. Do not exceed 75 mg in a 24-hour period for this indication. **Maximum Daily Dose:** * IR: 225 mg per day (for chronic use), 150 mg per day (for acute pain). * DR: 150 mg per day. * ER: 100 mg per day. ## Pediatric Dosing Dosing in pediatric patients is not well-established for most indications. Some sources suggest: * **Rheumatoid Arthritis:** 1-3 mg/kg/day in divided doses. Maximum dose not to exceed adult maximum. **Note:** Diclofenac is generally not recommended for children under 1 year of age. Specific pediatric dosing should be guided by institutional protocols and expert consultation. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. No specific dose adjustment is recommended for mild to moderate hepatic impairment, but monitoring is advised. Avoid in severe hepatic impairment. * **Renal Impairment:** Use with caution. No specific dose adjustment is recommended for mild to moderate renal impairment, but monitoring is advised. Avoid in severe renal impairment. ## Contraindications * Known hypersensitivity to diclofenac, aspirin, or other NSAIDs. * History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, rash, dizziness, headache. * **Serious:** * Cardiovascular events (myocardial infarction, stroke) * Gastrointestinal bleeding, ulceration, perforation * Hepatotoxicity (elevated liver enzymes, hepatitis, jaundice) * Renal toxicity (acute kidney injury) * Fluid retention, edema * Hypertension * Hypersensitivity reactions (anaphylaxis) ## Key Drug Interactions * **ACE inhibitors, Angiotensin Receptor Blockers (ARBs):** Increased risk of renal impairment and reduced antihypertensive effect. * **Diuretics:** Reduced diuretic efficacy and increased risk of renal impairment. * **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **Other NSAIDs (including aspirin):** Additive toxicity, increased risk of adverse effects. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate levels and potential for toxicity. * **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding. ## Monitoring * **Baseline and periodic renal function tests** (serum creatinine, BUN). * **Baseline and periodic liver function tests** (AST, ALT). * **Blood pressure** monitoring. * **Signs and symptoms of gastrointestinal bleeding** (melena, hematemesis, abdominal pain). * **Signs and symptoms of cardiovascular events.** ## Clinical Pearls * Administer with food or milk to minimize gastrointestinal upset. * Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse effects. * Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution. * Consider gastroprotective agents (e.g., PPIs) for patients at high risk of gastrointestinal complications. * Avoid concomitant use with other NSAIDs. * The risk of cardiovascular thrombotic events, myocardial infarction, and stroke may increase with the duration of NSAID use. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional and refer to the most current prescribing information for accurate and up-to-date guidance.*