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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Acute pain (musculoskeletal, dental).
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Can be initiated with a 100 mg dose, followed by 50 mg doses. Do not exceed 150 mg in the first 24 hours.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Alternatively, initiate with 100 mg, followed by 50 mg doses. Do not exceed 200 mg on the first day, and 150 mg on subsequent days.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Children 2 years and older: 1-3 mg/kg/day in divided doses. Maximum daily dose: 100 mg. Dosing should be individualized and based on clinical response.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Monitor liver function. Dose reduction may be necessary.
* **Renal Impairment:** Use with caution. Monitor renal function. Not recommended in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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, GI bleeding, perforation, ulceration.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension. Edema.
* **Renal:** Renal insufficiency, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus, photosensitivity.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Diminished antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Baseline and periodic monitoring of renal function (BUN, creatinine), liver function (AST, ALT), and complete blood count (CBC).**
* **Monitor for signs and symptoms of GI bleeding or ulceration.**
* **Monitor blood pressure.**
* **Monitor for signs of cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize the risk of cardiovascular and GI adverse events.
* Administer with food or milk to decrease GI upset.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and monitored.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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***Disclaimer:** This information is intended for healthcare professionals and does not replace professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosage and administration may vary based on individual patient factors and local protocols.*
