Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and lower fever.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily in 3-4 divided doses. Maximum dose is 200 mg per day.
* **Mild to Moderate Pain, Primary Dysmenorrhea:** Initial dose of 50 mg three times daily. Alternatively, an initial dose of 100 mg followed by 50 mg doses as needed. Do not exceed 200 mg per day.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for oral diclofenac due to safety concerns and limited data.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; a dose reduction may be considered in patients with mild to moderate hepatic impairment. Avoid use in severe hepatic impairment.
* **Renal Impairment:** Use with caution; consider a lower starting dose and close monitoring. Avoid use in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* History of GI bleeding or perforation related to previous NSAID use.
* Heart failure (NYHA Class II-IV).
## Adverse Effects
* **Common:** Dyspepsia, nausea, vomiting, diarrhea, abdominal pain, constipation, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), serious gastrointestinal bleeding, ulceration, perforation, hypertension, renal failure, hepatic failure, anaphylaxis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE Inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **GI:** Monitor for signs and symptoms of bleeding and ulceration.
* **Cardiovascular:** Assess blood pressure; monitor for signs of thrombotic events.
* **Renal:** Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic:** Monitor liver function tests (ALT, AST) especially in patients with pre-existing liver disease or those receiving long-term therapy.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of cardiovascular and GI events.
* Consider alternative analgesics in patients at high risk for GI complications or cardiovascular events.
* Do not co-administer with other NSAIDs.
***
**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information with the official product labeling and relevant guidelines.
