Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Menstrual pain (dysmenorrhea)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day, divided into 3 or 4 doses. Maximum recommended daily dose is 200 mg.
* **Acute Pain:** 50 mg three times daily, as needed.
* **Dysmenorrhea:** 50 mg three times daily, as needed. The maximum daily dose should not exceed 200 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most oral formulations. Specific product labeling should be consulted. Extended-release formulations are generally not recommended for children under 16 years of age.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Lower doses may be appropriate in patients with mild to moderate hepatic impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function, especially in patients with pre-existing renal disease or risk factors for renal impairment (e.g., dehydration, heart failure, diuretic use). Avoid in severe renal impairment.
## 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.
* Avoid use in patients with inflammatory bowel disease.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, elevated liver enzymes, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatotoxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, increased blood pressure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** Decreased antiplatelet effect of aspirin and increased risk of GI toxicity.
* **Corticosteroids:** Increased risk of GI toxicity.
* **Diuretics:** Reduced diuretic effect and increased risk of nephrotoxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
* **SSRIs/SNRIs:** Increased risk of bleeding.
## Monitoring
* Blood pressure.
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Signs and symptoms of GI bleeding or ulceration.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* The lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Patients at risk for GI bleeding (e.g., elderly, history of ulcers) may benefit from concurrent gastroprotection (e.g., PPI).
* NSAIDs can mask signs of infection.
* Discontinue immediately if signs of hepatotoxicity or serious cardiovascular event occur.
***
**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.
