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# Diclofenac
## 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, including menstrual cramps (dysmenorrhea)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily. Maximum daily dose: 150 mg.
* **Pain and Dysmenorrhea:** 50 mg orally every 8 hours as needed. Alternatively, an initial dose of 100 mg orally, followed by 50 mg orally if needed, to reach a total daily dose of up to 200 mg.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-12 years: 1-3 mg/kg/day in divided doses. Maximum daily dose: 200 mg.
* **Pain and Dysmenorrhea:** Not established in pediatric patients for these indications.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start at the lower end of the dosing range.
* **Renal Impairment:** Use with caution. Monitor renal function.
## Contraindications
* Known 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:** Abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; 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:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Blood pressure.
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
## Clinical Pearls
* Administer with food or milk to minimize gastric upset.
* Consider the lowest effective dose for the shortest duration necessary to reduce the risk of serious adverse effects.
* NSAIDs carry a boxed warning for cardiovascular and gastrointestinal risks.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.*
