Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, dysmenorrhea, and acute musculoskeletal disorders.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, or 75 mg orally twice daily.
* **Acute Pain, Primary Dysmenorrhea:** 50 mg orally three times daily as needed.
* **Maximum Daily Dose:** 225 mg.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Doses vary based on weight and are typically initiated by a pediatric rheumatologist. Dosing is generally around 1-3 mg/kg/day in divided doses.
* **Other Indications:** Use in children is generally not recommended unless specifically indicated and monitored by a specialist.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Monitor liver function. Maximum daily dose should not exceed 100 mg.
* **Renal Impairment:** Use with caution. Avoid if possible in severe renal 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.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation), dyspepsia, abdominal pain, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatotoxicity, renal toxicity, 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.
* **ACE inhibitors/ARBs/Diuretics:** Decreased antihypertensive effect, increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Baseline:** Renal function (SCr, BUN), liver function (AST, ALT), CBC.
* **Periodic:** Renal function, liver function (especially with prolonged use or underlying hepatic disease), blood pressure, signs of GI bleeding.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration should be used to minimize risk.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI complications.
* Patients with asthma may be at increased risk for bronchospasm.
---
*This information is for educational purposes only and does not substitute for professional medical advice. Always verify the most current prescribing information with official sources.*
