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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate 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: 225 mg.
* **Pain, Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum daily dose: 150 mg.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Maximum initial dose: 100 mg. Maximum daily dose: 150 mg for the first day.
## Pediatric Dosing
Dosing in pediatric patients is not well established for most indications. Available data is limited. Consult specific pediatric guidelines or literature for potential use.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are routinely recommended, but patients should be monitored for signs of hepatic toxicity.
* **Renal Impairment:** Use with caution, especially in patients with severe renal impairment. NSAIDs can cause renal toxicity.
## 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 (GI) bleeding or ulceration.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, hepatic failure, renal failure, severe skin reactions (e.g., Stevens-Johnson syndrome), anaphylaxis.
## 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 GI toxicity and other adverse effects.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* **Cardiovascular Risk:** Assess cardiovascular risk factors. Patients with established cardiovascular disease or risk factors are at higher risk.
* **Renal Function:** Monitor renal function, especially in patients with pre-existing renal disease or those receiving concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor liver function tests, especially with long-term use or in patients with underlying liver disease.
* **Blood Pressure:** Monitor blood pressure, as NSAIDs can elevate it.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize GI and cardiovascular risks.
* Consider concomitant gastroprotection (e.g., PPI) in patients at high risk for GI events.
* NSAIDs can mask signs and symptoms of infection.
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before initiating or modifying therapy.
