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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and joint stiffness caused by arthritis.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day, divided into 2 or 3 doses. Maximum daily dose: 200 mg.
* **Acute Pain:** Initial dose: 50 mg. Then 50 mg every 8 hours as needed. Do not exceed 150 mg in the first 24 hours.
* **Primary Dysmenorrhea:** Initial dose: 50 mg. Then 25-50 mg every 8 hours as needed. Do not exceed 200 mg in the first 24 hours.
## Pediatric Dosing
Dosing in pediatric patients is not well established. Consult specific pediatric guidelines.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; may require dose reduction.
* **Renal Impairment:** Use with caution; NSAIDs can impair renal function.
## Contraindications
* Known 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.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatic toxicity, renal toxicity, hypersensitivity reactions, exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** 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 and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Baseline and periodic monitoring of liver function tests (LFTs) and renal function tests (e.g., serum creatinine, BUN).
* Monitor for signs and symptoms of GI bleeding and cardiovascular events.
## Clinical Pearls
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Consider concomitant gastroprotection (e.g., PPI) in patients at increased risk of GI complications.
* Patients with cardiovascular disease or risk factors should be carefully evaluated before initiating diclofenac.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
