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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg per day, divided into 2-4 doses. Maximum: 200 mg/day.
* **Pain, Primary Dysmenorrhea:**
* Initial dose: 50 mg three times daily.
* Alternatively, a 75 mg dose may be given twice daily.
* Maximum: 225 mg/day.
* Extended-release formulations: 100 mg once daily. Maximum: 100 mg/day.
## Pediatric Dosing
* **Pain and Inflammation (ages 2-12 years):** 1-3 mg/kg/day divided into 3-4 doses. Maximum: 200 mg/day. *Note: Dosing for pediatric patients should be carefully calculated by weight.*
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose and monitor liver function closely.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Not recommended for severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active peptic ulceration or gastrointestinal (GI) bleeding.
* History of GI bleeding or perforation related to previous NSAID use.
* History of recurrent peptic ulceration or bleeding.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Late pregnancy (third trimester).
* Severe hepatic or renal impairment.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, headache, dizziness, rash.
* **Serious:** GI bleeding, ulceration, perforation, myocardial infarction, stroke, hypertension, renal failure, hepatic failure, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Decreased diuretic efficacy; increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **ACE inhibitors/ARBs:** Increased risk of renal impairment.
## Monitoring
* **Baseline and periodic:** Liver function tests (LFTs), renal function (serum creatinine, BUN), complete blood count (CBC).
* **Monitor for:** Signs and symptoms of GI bleeding (melena, hematemesis), cardiovascular events (chest pain, shortness of breath), and hypersensitivity reactions.
## Clinical Pearls
* The lowest effective dose should be used for the shortest duration necessary to minimize GI and cardiovascular risks.
* Administer with food or milk to reduce GI upset.
* Avoid concomitant use with other NSAIDs.
* Risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke may occur from the first dose and may increase with duration of use.
* NSAIDs can lead to new or worsening hypertension.
* Can cause renal papillary necrosis and other renal injury.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.*
