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# Diclofenac (Oral Tablet)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily or 75 mg orally twice daily. The maximum daily dose is 225 mg.
* **Acute Pain:** 50 mg orally three times daily as needed.
* **Extended-Release Formulations:** Varies by product, consult specific labeling.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be determined by a specialist.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Initiate at the lower end of the dosing range. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache, rash.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatotoxicity, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs or Salicylates:** Increased risk of gastrointestinal side effects and reduced therapeutic effect.
* **ACE Inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI Symptoms:** Monitor for signs and symptoms of gastrointestinal bleeding and ulceration.
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with risk factors for renal impairment.
* **Liver Function:** Monitor liver enzymes, especially with long-term use or in patients with pre-existing liver disease.
* **Cardiovascular Risk:** Assess cardiovascular risk factors.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider co-administration of a proton pump inhibitor (PPI) or misoprostol for patients at high risk of gastrointestinal complications.
* Discontinue diclofenac immediately if signs of serious cardiovascular, renal, or hepatic events occur.
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and a qualified healthcare provider for any medical decisions.
