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# Diclofenac ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. ## Primary Indications * Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. * Mild to moderate pain. * Acute gouty arthritis. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg per day in divided doses (e.g., 50 mg TID or 75 mg BID). Maximum daily dose is 200 mg. * **Mild to Moderate Pain:** 25 mg every 6-8 hours as needed. Do not exceed 75 mg in 24 hours. * **Acute Gouty Arthritis:** 50 mg TID for 3 days. ## Pediatric Dosing * **Rheumatoid Arthritis:** 2-3 mg/kg per day in divided doses. Maximum daily dose is 200 mg. Dosing for children under 1 year is not established. ## Dose Adjustments * **Hepatic Impairment:** Use with caution; consider lower doses. * **Renal Impairment:** Use with caution; monitor renal function. Data for severe renal impairment is limited. ## 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 * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dizziness, headache. * **Serious:** * **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure. * **Gastrointestinal:** Ulceration, bleeding, perforation. * **Hepatic:** Elevated liver enzymes, hepatitis. * **Renal:** Renal impairment, interstitial nephritis. * **Dermatologic:** Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis). * **Hypersensitivity:** Anaphylaxis. ## Key Drug Interactions * **ACE Inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Diuretics:** Reduced diuretic and antihypertensive effect; increased risk of renal impairment. * **Lithium, Methotrexate:** Increased serum concentrations and toxicity. * **Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding. * **Warfarin:** Increased risk of bleeding. ## Monitoring * **Baseline and periodic:** Liver function tests (LFTs), renal function tests (BUN, creatinine), complete blood count (CBC). * Monitor for signs and symptoms of GI bleeding, cardiovascular events, and hypersensitivity reactions. ## Clinical Pearls * 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 bleeding. * NSAIDs can mask signs of infection. * Avoid concurrent use with other NSAIDs. *** *Please verify current prescribing information for the most up-to-date details on dosing, contraindications, and interactions.*