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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg orally per day, divided into 2 or 3 doses. Maximum dose is 200 mg per day.
* **Mild to moderate pain, Primary Dysmenorrhea:** Initial dose of 50 mg orally three times a day. Subsequent doses may be 50 mg every 8 hours as needed. Do not exceed 200 mg per day.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day orally, divided into 2-4 doses. Maximum dose is 200 mg per day. **Limited data available; use with caution.**
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider dose reduction in patients with mild to moderate hepatic impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Consider dose reduction in patients with mild to moderate renal impairment. Avoid in severe renal impairment.
## 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
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal failure, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects.
## Monitoring
* **GI:** Monitor for signs and symptoms of GI bleeding and ulceration.
* **Renal:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic:** Monitor liver function tests, especially in patients with pre-existing liver disease or those at risk.
* **Cardiovascular:** Assess cardiovascular risk factors.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Avoid concurrent use with other NSAIDs.
This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details.
