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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce inflammation and pain.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily or 75 mg orally twice daily. Extended-release formulations: 75 mg to 150 mg once daily.
* **Acute Pain:** 50 mg orally three times daily as needed.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed.
* **Maximum Daily Dose:** 200 mg (immediate-release) or 150 mg (extended-release). Local protocols may differ.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Children 2 to 12 years: 1-3 mg/kg/day orally divided into 2-4 doses. Maximum daily dose is 3 mg/kg/day or 100 mg/day, whichever is less.
* Dosing for other indications in pediatrics is not well-established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited for severe renal impairment.
* **Hepatic Impairment:** Use with caution. May be necessary to reduce dose.
* **Elderly:** Increased risk of GI bleeding and renal toxicity; consider lower doses.
## 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:** Abdominal pain, nausea, vomiting, diarrhea, dyspepsia, flatulence, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI perforation, ulceration, bleeding, hypertension, renal failure, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, anemia.
## Key Drug Interactions
* **ACE inhibitors/ARBs:** Increased risk of renal impairment.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics:** Reduced efficacy; increased risk of renal impairment.
## Monitoring
* **Baseline and periodic:** Renal function (BUN, creatinine), liver function tests (AST, ALT), complete blood count (CBC), blood pressure.
* Monitor for signs and symptoms of GI bleeding and cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize adverse effects.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* NSAIDs can mask signs of infection.
* Concurrent use with aspirin 81 mg may reduce the cardioprotective effect of aspirin; consider timing of doses if used concurrently.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines before making clinical decisions.*
