Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2-3 times daily or 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Pain, Primary Dysmenorrhea:** Initial dose: 50 mg orally 3 times daily. May increase to 75 mg orally twice daily if needed. Maximum daily dose: 225 mg.
* **Delayed-release tablets:** 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Extended-release tablets:** 100 mg orally once daily. Maximum daily dose: 100 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most indications. Diclofenac is generally not recommended for children under 14 years of age for pain and inflammation, except in specific circumstances under specialist guidance.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose and monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
* **Elderly:** Increased risk of GI bleeding, renal, and cardiovascular events. Use lowest effective dose for shortest duration.
## 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.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, edema.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE Inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Creatinine, BUN, urine output, especially in patients with pre-existing renal disease or risk factors.
* **Hepatic function:** Liver enzymes (AST, ALT), bilirubin, especially in patients with liver disease or those on long-term therapy.
* **Gastrointestinal:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* **Cardiovascular:** Blood pressure, signs of fluid retention.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize adverse effects.
* Administer with food or milk to reduce gastric upset.
* Delayed-release and extended-release formulations should not be crushed or chewed.
* Risk of cardiovascular thrombotic events, myocardial infarction, and stroke is increased with NSAID use.
***
This information is intended for healthcare professionals. Always verify current prescribing information with official drug monographs and local protocols before initiating therapy.
