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# Diclofenac Tablets
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum: 150 mg/day.
* **Mild to Moderate Pain:** 50 mg orally every 8 hours as needed. Maximum: 150 mg/day.
* **Delayed-release or Enteric-coated tablets:** Typically 37.5 mg to 50 mg orally three to four times daily. Maximum: 150 mg/day.
* **Extended-release tablets:** 100 mg orally once daily. May increase to 200 mg once daily if needed.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most formulations. For specific indications and age groups, consult specialized pediatric formularies or literature.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatotoxicity, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (serum creatinine, BUN).
* Liver function tests (ALT, AST).
* Blood pressure.
* Signs of fluid retention or edema.
## 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.
* Patients with risk factors for cardiovascular disease or GI bleeding should be carefully evaluated before initiating therapy.
* Consider alternative analgesics for patients with a history of NSAID-induced bronchospasm.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
