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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis:** 150 mg daily in 2 to 3 divided doses. Extended-release formulations may be given once daily.
* **Pain and Primary dysmenorrhea:** Initial dose of 50 mg, followed by 50 mg doses as needed, not to exceed 200 mg on the first day, and not to exceed 150 mg on subsequent days. Alternatively, 50 mg three times daily.
* **Maximum Daily Dose:** 150 mg (for chronic conditions). For acute pain, up to 200 mg on the first day.
## Pediatric Dosing
* **Children ≥ 1 year:**
* **Rheumatoid arthritis:** 1-3 mg/kg/day in 2 to 4 divided doses. Maximum daily dose is 100 mg.
* **Pain and inflammation (other than rheumatoid arthritis):** 1-2 mg/kg/day in 2 to 4 divided doses. Maximum daily dose is 100 mg.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited, but consider a reduced dose in severe impairment.
* **Hepatic Impairment:** Use with caution. Start with a lower dose and titrate carefully. Avoid in severe hepatic impairment.
## 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.
* Inflammatory bowel disease.
* Heart failure.
## Adverse Effects
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; hypertension; fluid retention and edema; exacerbation of asthma; anaphylaxis.
## 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.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI:** Signs and symptoms of bleeding or ulceration.
* **Renal:** Renal function (creatinine, BUN).
* **Hepatic:** Liver function tests (ALT, AST).
* **Cardiovascular:** Blood pressure, signs of fluid retention.
## Clinical Pearls
* Lowest effective dose for the shortest duration.
* Consider concomitant gastroprotection (e.g., PPI) in patients at high risk for GI events.
* NSAIDs carry a risk of cardiovascular and GI events, which may increase with duration of use and higher doses.
**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always refer to the most current prescribing information and consult with a qualified healthcare provider for patient-specific advice.
