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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily or 75 mg twice daily. Maximum: 225 mg/day.
* **Pain (mild to moderate):** 50 mg every 8-12 hours as needed. Maximum: 150 mg/day for short-term use.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day in divided doses. Maximum: 75 mg/day. Dosing typically starts at the lower end of the range. Not recommended for children under 1 year.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose.
* **Renal Impairment:** Use with caution. Monitor closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or GI bleeding.
* History of NSAID-induced bronchospasm, urticaria, or allergic-type reactions.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, perforation, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatotoxicity, hypertension, fluid retention, edema, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics:** Decreased diuretic efficacy and increased risk of renal impairment.
* **ACE inhibitors/ARBs:** Increased risk of renal impairment and reduced antihypertensive effect.
## Monitoring
* Monitor for signs and symptoms of GI bleeding.
* Monitor renal function (BUN, creatinine) and electrolytes, especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function tests (LFTs), especially with chronic use or in patients with underlying liver disease.
* Monitor blood pressure.
* Assess pain and inflammation levels.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious adverse events.
* Advise patients to avoid concomitant use of other NSAIDs or aspirin unless directed by a healthcare provider.
* Risk of cardiovascular events may increase with duration of use and in patients with risk factors.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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*Disclaimer: 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 best course of treatment for your specific condition. Verify current prescribing information for complete details.*
