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# Diclofenac (Oral) ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. ## Primary Indications * Pain (mild to moderate) * Inflammatory conditions (e.g., osteoarthritis, rheumatoid arthritis) ## Adult Dosing * **Immediate-release:** 50 mg two to three times daily. Maximum daily dose: 150 mg. * **Delayed-release:** 75 mg twice daily. Maximum daily dose: 150 mg. * **Extended-release:** 100 mg once daily or 75 mg twice daily. Maximum daily dose: 100 mg for once-daily dosing, 150 mg for twice-daily dosing. Dosing should be titrated to the lowest effective dose. ## Pediatric Dosing * **Pain and inflammation (ages 1 to 12 years):** 1-3 mg/kg/day divided into 2-3 doses. Maximum daily dose: 4 mg/kg/day or 150 mg/day, whichever is less. *Specific dosing depends on local protocol and indication.* ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Maximum daily dose should be reduced. Avoid if severe hepatic impairment. * **Renal Impairment:** Use with caution. Avoid in severe renal 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. * Inflammatory bowel disease (active or history). * Congestive heart failure. * Third trimester of pregnancy. ## Adverse Effects * **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, dizziness, headache, elevated liver enzymes. * **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypertension; fluid retention; hypersensitivity reactions. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration/bleeding. * **SSRIs/SNRIs:** Increased risk of GI bleeding. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect, increased risk of renal impairment. * **Lithium, Methotrexate:** Increased serum levels and toxicity. ## Monitoring * **Baseline and periodic:** Renal function (BUN, creatinine), liver function tests (ALT, AST), complete blood count (CBC). * **With prolonged use:** Assess for signs/symptoms of GI bleeding, cardiovascular events, and renal/hepatic dysfunction. ## Clinical Pearls * Administer with food or milk to minimize GI upset. * Use the lowest effective dose for the shortest duration necessary. * Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications. * NSAIDs can mask signs of infection. * Withdrawal of NSAIDs may unmask signs of renal disease. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Dosing may vary based on patient-specific factors and local protocols.