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# Diclofenac (Oral) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and joint stiffness. ## Primary Indications * Osteoarthritis * Rheumatoid arthritis * Ankylosing spondylitis * Acute pain * Menstrual pain (dysmenorrhea) ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** * Immediate-release: 150 mg daily in 3-4 divided doses (e.g., 50 mg TID or 75 mg BID). * Delayed-release: 75 mg twice daily. * Maximum daily dose: 225 mg. * **Acute Pain:** 50 mg every 8 hours as needed for the first day, then 50 mg every 12 hours or every 8 hours thereafter. Maximum daily dose: 150 mg. * **Primary Dysmenorrhea:** 50 mg three times daily as needed. Maximum daily dose: 150 mg. Dosing may vary based on formulation (e.g., extended-release). Always consult specific product labeling. ## Pediatric Dosing Use in pediatric patients is generally not recommended for oral formulations unless specifically indicated and under specialist guidance. Dosing is not well-established for many indications. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction. Avoid use in severe hepatic impairment. * **Renal Impairment:** Use with caution. Monitor renal function. No specific dose adjustment is typically recommended for mild to moderate impairment, but dose reduction may be considered. Avoid in severe renal impairment. ## 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. * Active peptic ulceration or GI bleeding. ## Adverse Effects * **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, flatulence, dizziness, headache, rash. * **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **SSRIs/SNRIs:** Increased risk of GI bleeding. * **Diuretics:** Reduced efficacy, increased risk of renal toxicity. * **ACE inhibitors/ARBs:** Increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. ## Monitoring * Signs and symptoms of GI bleeding or ulceration. * Renal function (BUN, creatinine). * Liver function tests (AST, ALT). * Blood pressure. * Signs and symptoms of cardiovascular events. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce GI upset. * Avoid concomitant use with other NSAIDs. * Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications. --- **Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult with appropriate resources before making clinical decisions.