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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Menstrual cramps (dysmenorrhea)
## Adult Dosing
* **Pain/Dysmenorrhea:** 400 mg every 12 hours as needed. Maximum daily dose is 800 mg.
* **Osteoarthritis/Rheumatoid Arthritis/Ankylosing Spondylitis:** 400 mg every 12 hours. Maximum daily dose is 800 mg.
## Pediatric Dosing
* **Age < 16 years:** Dosing not established due to safety concerns.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is typically recommended, but monitoring for adverse effects is crucial. Severe hepatic impairment is a contraindication.
* **Renal Impairment:** Use with caution, especially in patients with pre-existing renal disease. Monitor renal function. Consider alternative agents if renal impairment is severe.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* History of gastrointestinal bleeding or perforation related to prior NSAID use.
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
* Perioperative pain in the context of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatotoxicity; hypersensitivity reactions; fluid retention; hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics:** Reduced antihypertensive effect and increased risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Baseline and periodic renal function tests (serum creatinine, BUN).**
* **Baseline and periodic liver function tests (ALT, AST).**
* **Monitor for signs and symptoms of gastrointestinal bleeding (melena, hematemesis).**
* **Monitor for signs and symptoms of cardiovascular events.**
* **Monitor blood pressure.**
## Clinical Pearls
* 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 events.
* Patients with a history of inflammatory bowel disease should use with caution.
* Avoid concomitant use with other NSAIDs.
* Withdraw diclofenac if any signs of hepatotoxicity or serious adverse event occur.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and your healthcare provider for any medical concerns or before making any decisions related to your health or treatment.
