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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis.
## Primary Indications
* Pain relief
* Inflammation associated with conditions such as osteoarthritis and rheumatoid arthritis
## Adult Dosing
* **Immediate-release:** 50 mg orally two to three times daily. Maximum daily dose: 200 mg.
* **Delayed-release:** 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Extended-release:** 100 mg orally once daily. Maximum daily dose: 100 mg.
Dosing for acute pain may vary based on local protocol.
## Pediatric Dosing
Use in pediatric patients is generally not recommended due to limited data and potential safety concerns. If used, close monitoring is essential. Specific dosing is not established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction; severe impairment is a contraindication.
* **Renal Impairment:** Use with caution, especially in patients with pre-existing renal disease. May require dose reduction. Monitor renal function closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or ulceration.
* History of GI bleeding or perforation related to prior NSAID use.
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal failure, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI toxicity and other adverse effects.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **SSRIs, SNRIs:** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Baseline and periodic:** Renal function (serum creatinine, BUN), liver function (AST, ALT), complete blood count (CBC), blood pressure.
* **Signs and symptoms of GI bleeding:** Melena, hematemesis.
* **Signs and symptoms of cardiovascular events.**
## Clinical Pearls
* Lowest effective dose for the shortest duration should be used.
* Consider risk factors for GI toxicity (age, history of ulcers, concurrent medications) and cardiovascular risk.
* Take with food or milk to reduce GI upset.
* Avoid concomitant use with other NSAIDs.
* Discontinue if significant adverse effects occur.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician before making any treatment decisions.*
