Please check your internet connection and try again.
# Diclofenac (Oral Tablet)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, or 75 mg orally twice daily.
* **Acute Pain:** Initial dose of 50 mg orally, followed by 50 mg every 8 hours as needed. A single dose of 100 mg orally can also be used initially.
* **Maximum Daily Dose:** 225 mg per day.
## Pediatric Dosing
Dosing for pediatric patients is not well-established for oral diclofenac tablets. Refer to specific pediatric guidelines or product labeling for available options.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose and monitor closely.
* **Renal Impairment:** Use with caution. Monitor renal function.
## Contraindications
* Known 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
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, elevated liver enzymes. Serious risks include GI bleeding, ulceration, and perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Other:** Dizziness, headache, rash, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Decreased antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **CYP2C9 Inhibitors (e.g., fluconazole):** May increase diclofenac levels.
## Monitoring
* Signs and symptoms of GI bleeding.
* Liver function tests (LFTs).
* Renal function tests (BUN, creatinine).
* Blood pressure.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* NSAIDs can mask signs of infection.
***
*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosages and safety information before making any treatment decisions.*
