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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that functions by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhea, and post-operative pain.
## Adult Dosing
* **Pain:** 25 mg to 50 mg orally every 8 hours as needed.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily or 75 mg orally twice daily.
* **Acute Pain/Dysmenorrhea:** 50 mg orally every 8 hours as needed.
* **Maximum Daily Dose:** 150 mg.
## Pediatric Dosing
* **Children 1 to 14 years:** Dosing varies by indication and is typically weight-based. Consult specific pediatric guidelines or product information. For example, for fever/pain, a common range is 1-3 mg/kg/day divided into 2-3 doses, not to exceed 3 mg/kg/day or adult maximum.
* **Adolescents 14 years and older:** Adult dosing can generally be applied.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is typically recommended for mild to moderate impairment, but monitor for adverse effects. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Start with a lower dose and monitor liver function closely. Avoid in severe hepatic impairment.
* **Elderly:** Consider lower doses and increased monitoring due to potential for increased adverse effects.
## 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.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure, renal failure, or hepatic failure.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, headache, dizziness.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure.
* **Gastrointestinal:** Ulceration, bleeding, perforation.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hematologic:** Anemia, bruising.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **SSRIs:** Increased risk of GI bleeding.
## Monitoring
* **GI:** Monitor for signs and symptoms of GI bleeding (melena, hematemesis) and ulceration.
* **Renal:** Monitor renal function (serum creatinine, BUN) especially in patients with pre-existing renal disease or those at risk.
* **Hepatic:** Monitor liver function tests (ALT, AST) regularly, especially with long-term use or in patients with liver disease.
* **Cardiovascular:** Assess for signs and symptoms of cardiovascular events.
* **Blood Pressure:** Monitor blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with asthma, particularly those with nasal polyps and angioedema, may have an increased risk of severe reactions.
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This information is intended for clinical decision support and does not replace the need to consult the official prescribing information and current clinical guidelines. Always verify current drug information before making clinical decisions.
