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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute musculoskeletal disorders.
## Adult Dosing
* **Immediate-release:** 150-200 mg orally per day, divided into 3-4 doses. Maximum: 225 mg/day.
* **Delayed-release:** 180-200 mg orally once daily. Maximum: 200 mg/day.
* **Extended-release:** 100-200 mg orally once daily. Maximum: 200 mg/day.
*Note: Dosing may vary based on specific formulation and indication. Always consult product labeling or local protocol.*
## Pediatric Dosing
* **Age 1-12 years:** 1-3 mg/kg/day orally, divided into 2-4 doses. Maximum: 200 mg/day. *Typically used for juvenile idiopathic arthritis.*
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary.
* **Renal Impairment:** Use with caution. Monitor renal function. Generally no dose adjustment required for mild to moderate impairment, but avoid if severe.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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 or perforation.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatic failure, 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.
* **ACE inhibitors, ARBs, diuretics:** Decreased antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Hemoglobin/hematocrit for signs of GI bleeding.
* Blood pressure.
* Signs and symptoms of cardiovascular events.
* Signs and symptoms of GI toxicity.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Consider gastroprotection (e.g., PPI) in patients with increased risk of GI events.
* Monitor for signs of fluid retention and edema.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering medications.*
