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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, inflammation, and fever.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* 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 is 225 mg.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Maximum daily dose is 150 mg.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum daily dose is 200 mg.
* **Delayed-Release Tablets:** Doses are typically taken 30-60 minutes before meals to improve absorption, but can be taken with food to reduce GI upset.
* **Extended-Release Tablets:** 100 mg orally once daily.
## Pediatric Dosing
Dosing is not well-established for children. Consult specific pediatric guidelines.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; reduced doses may be considered.
* **Renal Impairment:** Use with caution; monitor renal function. May require dose reduction in severe impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), hypertension, fluid retention, edema, renal impairment/failure, hepatic impairment, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## 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 and ARBs:** May increase risk of renal impairment; reduced antihypertensive effect.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Gastrointestinal:** Signs and symptoms of bleeding (melena, hematemesis).
* **Cardiovascular:** Blood pressure, signs of fluid retention.
* **Renal:** Serum creatinine, BUN.
* **Hepatic:** Liver function tests (AST, ALT).
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider concomitant gastroprotective agents (e.g., PPIs) in patients at high risk for GI events.
* Risk of cardiovascular events and GI bleeding increases with duration of use and dose.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult current prescribing information and your healthcare provider for any medical decisions.*
