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# Diclofenac (Oral) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of mild to moderate pain and inflammation. ## Primary Indications * Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. * Mild to moderate pain, including pain associated with dysmenorrhea. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg daily, divided into 2 or 3 doses. Typical starting dose is 50 mg TID or 75 mg BID. Maximum daily dose is 200 mg. * **Acute Pain or Dysmenorrhea:** Initial dose of 50 mg TID as needed. Alternatively, 100 mg initially, followed by 50 mg doses as needed to a total daily dose not exceeding 200 mg. For dysmenorrhea, treatment should not exceed 5 days. ## Pediatric Dosing * **Rheumatoid Arthritis:** 1 mg/kg/day divided into 2 or 3 doses. Maximum daily dose is 3 mg/kg/day or 100 mg/day, whichever is less. Dosing for children under 1 year is not established. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Start at the lower end of the dosing range. Monitor closely. Dose reduction may be necessary. * **Renal Impairment:** Use with caution. Monitor renal function. Dose reduction may be necessary. ## 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. * Children under 1 year of age for rheumatoid arthritis. ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache. * **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), GI bleeding, ulceration, perforation, hepatotoxicity, renal toxicity, hypersensitivity reactions, exacerbation of asthma. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment. * **Diuretics:** Reduced diuretic effect; increased risk of renal impairment. * **Lithium, Methotrexate:** Increased serum levels and toxicity. ## Monitoring * Renal function (serum creatinine, BUN). * Liver function tests (ALT, AST). * Blood pressure. * Signs and symptoms of GI bleeding or ulceration. * Signs and symptoms of cardiovascular events. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events. * Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications. * Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution. * Concurrent use with other NSAIDs, including aspirin, should be avoided unless specifically indicated and with extreme caution due to increased risk of adverse effects. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*