Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily, or 75 mg twice daily. Maximum: 225 mg daily.
* **Acute Pain:** 50 mg every 8 hours as needed for the first dose, then 50 mg every 6-8 hours as needed. Maximum: 150 mg daily.
* **Dysmenorrhea:** 50 mg every 8 hours as needed for the first dose, then 50 mg every 6-8 hours as needed. Maximum: 150 mg daily.
## Pediatric Dosing
* **Inflammatory Conditions (ages 2-12 years):** 1-3 mg/kg/day divided into 2-4 doses. Maximum: 75 mg daily. *Dosing varies significantly by indication and local protocol; close monitoring is essential.*
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is recommended, but initiate at the lower end of the dosing range and monitor closely.
* **Renal Impairment:** Use with caution. No specific dose adjustment is recommended, but initiate at the lower end of the dosing range and monitor closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active gastrointestinal bleeding or perforation.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding/perforation, renal toxicity, hepatic failure, anaphylaxis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors and ARBs:** Increased risk of renal impairment.
* **Diuretics:** Decreased diuretic efficacy and increased risk of renal impairment.
* **Lithium and Methotrexate:** Increased serum levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine) and electrolytes.
* Liver function tests (ALT, AST).
* Blood pressure.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious adverse events.
* Patients with pre-existing cardiovascular disease or risk factors are at increased risk of cardiovascular events.
* NSAIDs can mask signs of infection.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
