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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Mild to moderate pain.
* Dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily, or 75 mg twice daily. Maximum daily dose: 225 mg.
* **Mild to moderate pain and Dysmenorrhea:** 50 mg every 8 hours as needed. Initial dose: 50 mg, followed by 50 mg every 8 hours. Do not exceed 200 mg in the first 24 hours.
## Pediatric Dosing
Dosing in pediatric patients is not well established for oral diclofenac for most indications. Consult specialized pediatric resources for specific age and weight-based dosing if considered.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Moderate impairment may require dose reduction. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Patients with pre-existing renal disease may be at increased risk. Monitor renal function closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive efficacy; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Blood pressure.
* For patients with cardiovascular risk factors, assess for cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Patients with asthma, particularly those with nasal polyps and/or angioedema, may have an increased risk of severe bronchospasm.
**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and relevant guidelines for complete details.
