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# Diclofenac (Oral) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. ## Primary Indications * Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. * Mild to moderate pain. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 250 mg to 300 mg per day, divided into 2 to 3 doses. Maximum daily dose: 300 mg. * **Mild to Moderate Pain:** 250 mg to 300 mg per day, divided into 2 to 3 doses. Maximum daily dose: 300 mg. * **Extended-release formulations:** Dosing varies by product, often once or twice daily. Consult specific product labeling. ## Pediatric Dosing * Data is limited. Generally not recommended for children under 14 years of age for arthritis. * For other indications, use is based on physician judgment and product labeling may provide specific recommendations. For example, some formulations may be dosed at 1-3 mg/kg/day divided into 2-3 doses for pediatric patients weighing over 50 kg. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Dose reduction may be considered in mild to moderate impairment. Avoid in severe impairment. * **Renal Impairment:** Use with caution. Monitor renal function closely. Dose reduction may be necessary in severe impairment. ## 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 bleeding, ulceration, or perforation. ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, dyspepsia), dizziness, headache, rash. * **Serious:** Cardiovascular events (myocardial infarction, stroke), gastrointestinal bleeding/ulceration/perforation, hepatotoxicity, renal toxicity, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding. * **ACE inhibitors/ARBs:** Reduced antihypertensive effect; increased risk of renal impairment. * **Diuretics:** Reduced diuretic effect; increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. ## Monitoring * Liver function tests (LFTs) at baseline and periodically during long-term therapy. * Renal function tests (BUN, creatinine) at baseline and periodically. * Complete blood count (CBC) to monitor for anemia or gastrointestinal blood loss. * Signs and symptoms of gastrointestinal bleeding or ulceration. * Blood pressure. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary. * Administer with food or milk to minimize gastrointestinal upset. * Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications. * NSAIDs carry a risk of cardiovascular thrombotic events. *** *Please verify current prescribing information with the official product labeling for complete details.*