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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis:** 50 mg orally three times daily or 75 mg orally twice daily.
* **Acute Pain:** 50 mg orally every 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg orally every 8 hours as needed.
* **Maximum Daily Dose:** 200 mg.
Dose adjustments may be necessary based on patient response and tolerability.
## Pediatric Dosing
* **Juvenile Idiopathic Arthritis:**
* 1-12 years: 1-3 mg/kg/day orally in divided doses.
* **Maximum Daily Dose:** 4 mg/kg/day or 200 mg/day, whichever is less.
Use in children under 1 year is generally not recommended due to insufficient safety and efficacy data.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dosage reduction may be necessary in patients with mild to moderate hepatic impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Consider dosage reduction in patients with moderate to severe renal impairment. Monitor renal function closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Advanced renal disease.
* Advanced hepatic disease.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal perforation and bleeding, renal failure, hepatotoxicity, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), exacerbation of heart failure, anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, apixaban):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Cyclosporine, Tacrolimus:** Increased risk of nephrotoxicity.
## Monitoring
* **Renal Function:** Monitor BUN and creatinine, especially in patients with risk factors for renal impairment.
* **Hepatic Function:** Monitor LFTs, especially in patients with pre-existing liver disease or those on long-term therapy.
* **Gastrointestinal Symptoms:** Advise patients to report any signs of GI bleeding or ulceration (e.g., black tarry stools, persistent abdominal pain, vomiting blood).
* **Cardiovascular Risk Factors:** Assess and manage.
## Clinical Pearls
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications.
* Educate patients about the risks of cardiovascular events and gastrointestinal bleeding.
* Concurrent use with other NSAIDs should be avoided.
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*Disclaimer: This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and relevant guidelines before initiating or modifying drug therapy.*
