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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Enteric-coated or delayed-release tablets: 50 mg three times daily, or 75 mg twice daily.
* Extended-release tablets: 100 mg once daily.
* **Pain and Dysmenorrhea:**
* Immediate-release tablets: 50 mg three times daily as needed.
**Maximum Daily Dose:** 150 mg for immediate-release formulations, 200 mg for extended-release formulations.
## Pediatric Dosing
Limited data available. Generally not recommended for children under 12 years unless specifically prescribed. Dosing varies based on indication and weight.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction.
* **Renal Impairment:** Use with caution, especially in severe impairment.
## 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.
## Adverse Effects
* **Common:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hepatic injury, renal injury, fluid retention, edema, hypertension, hypersensitivity reactions.
## 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.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly GI bleeding.
* **ACE Inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic efficacy; increased risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum concentrations.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Liver function tests (LFTs), especially with long-term use or in patients with pre-existing liver disease.
* Renal function (BUN, creatinine), especially in patients with renal impairment or those at risk.
* Blood pressure.
* Signs of fluid retention or edema.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI events.
* Avoid in patients with uncontrolled hypertension or established cardiovascular disease if possible.
* Discontinue if signs of hepatotoxicity or severe adverse reactions occur.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete details and to verify this information before making clinical decisions.*
