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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily. Maximum daily dose: 150 mg.
* **Mild to moderate pain:** 25 mg orally every 4-6 hours as needed. Maximum daily dose: 100 mg. Some protocols may allow up to 75 mg orally every 8 hours, not to exceed 225 mg daily for acute pain management.
## Pediatric Dosing
Dosing in pediatric patients is not well established for most indications. Use is generally not recommended due to safety concerns.
## Dose Adjustments
No specific dose adjustment is typically required for renal or hepatic impairment, but caution and the lowest effective dose are recommended.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic 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.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect; increased risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor blood pressure.
* Monitor renal function (BUN, creatinine).
* Monitor liver function (AST, ALT).
* Assess pain and inflammation.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Consider gastroprotective agents (e.g., PPIs) for patients at increased risk of GI events.
* Black box warning regarding cardiovascular and GI risks.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
