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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, swelling, and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Acute pain, including musculoskeletal and dental pain.
## Adult Dosing
* **Osteoarthritis:** 200 mg/day divided into 2-4 doses, or a single sustained-release dose of 100-200 mg once daily. Maximum dose: 300 mg/day.
* **Rheumatoid Arthritis:** 200 mg/day divided into 2-4 doses. Maximum dose: 300 mg/day.
* **Ankylosing Spondylitis:** 100 mg/day divided into 2-4 doses. Maximum dose: 125 mg/day.
* **Acute Pain:** 25 mg to 50 mg every 6 to 8 hours as needed. Do not exceed 150 mg in 24 hours. A single dose of 100 mg may be given initially for acute pain.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for all indications and formulations. Specific recommendations depend on age, weight, and indication, and should be guided by available pediatric studies or institutional protocols.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is typically recommended, but monitor liver function closely.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
## Contraindications
* 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
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension.
* **Renal:** Renal impairment, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease diclofenac's cardioprotective effects; increased risk of GI bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Diuretics:** May reduce diuretic efficacy and increase nephrotoxicity.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
## Monitoring
* **Renal Function:** Serum creatinine, BUN.
* **Hepatic Function:** Liver enzymes (AST, ALT).
* **Gastrointestinal Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Cardiovascular Risk Factors:** Blood pressure, signs of edema.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious cardiovascular and gastrointestinal events.
* Avoid concomitant use with other NSAIDs.
* Patients with risk factors for cardiovascular disease or gastrointestinal bleeding should be carefully evaluated before initiating therapy.
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_This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriate course of treatment. Prescribing information may vary, and it is essential to review the most current official prescribing information for any medication before use._
