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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and manage fever. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Menstrual pain (dysmenorrhea)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** Typically 50 mg orally two to three times daily. Some formulations allow for 75 mg twice daily. Maximum daily dose is 150 mg.
* **Acute Pain:** Initial dose of 50 mg orally, followed by 50 mg every 8 hours as needed. Do not exceed 150 mg in 24 hours.
* **Dysmenorrhea:** Initial dose of 50 mg orally, followed by 50 mg every 8 hours as needed. Do not exceed 150 mg in 24 hours.
*Note: Doses can vary based on product formulation (e.g., immediate-release vs. delayed-release vs. extended-release) and specific clinical guidelines. Always consult local protocols.*
## Pediatric Dosing
Diclofenac is generally not recommended for pediatric use in the United States due to limited data and risk of toxicity. Some international guidelines may suggest use in specific pediatric populations and conditions, but this requires careful consideration and specialist guidance.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Starting dose may need to be reduced. Monitor liver function closely.
* **Renal Impairment:** Use with caution. Monitor renal function. Not recommended in severe renal impairment.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Use the lowest effective dose for the shortest duration necessary.
## Contraindications
* 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.
* Active gastrointestinal bleeding or perforation.
* Inflammatory bowel disease (active).
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, dizziness, headache.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure.
* **Gastrointestinal:** Ulceration, bleeding, perforation of the stomach or intestines.
* **Hepatic:** Elevated liver enzymes, hepatitis, liver failure.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Dermatologic:** Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis).
* **Hematologic:** Anemia, prolonged bleeding time.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Antiplatelet agents (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs and SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects.
## Monitoring
* **Baseline and periodic assessment of renal function** (serum creatinine, BUN).
* **Baseline and periodic assessment of liver function** (ALT, AST, bilirubin).
* **Monitor for signs and symptoms of gastrointestinal bleeding** (e.g., melena, hematemesis).
* **Monitor for signs and symptoms of cardiovascular events** (e.g., chest pain, shortness of breath).
* **Monitor blood pressure.**
## 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 gastroprotection (e.g., PPI) for patients at high risk of GI complications.
* Avoid concomitant use with other NSAIDs.
* Assess cardiovascular and renal risk factors before initiating therapy.
* Discontinue immediately if signs of hepatic or renal toxicity, or serious skin reaction occur.
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*Disclaimer: This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for definitive dosing, indications, contraindications, and safety information.*
