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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 3 times daily, or 75 mg orally twice daily. Maximum: 225 mg/day.
* **Mild to Moderate Pain, Primary Dysmenorrhea:** 50 mg orally every 8 hours as needed. Maximum: 150 mg/day. Alternatively, an initial dose of 100 mg orally, followed by 50 mg orally every 8 hours as needed. Maximum: 150 mg/day.
## Pediatric Dosing
Dosing for pediatric patients is not well-established for most oral formulations. Limited data exists for specific age groups and indications. Consult specialized pediatric resources.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction.
* **Renal Impairment:** Use with caution, particularly in severe 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.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, ulceration, bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension. Fluid retention, edema.
* **Renal:** Acute kidney injury, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
## 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:** 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
* **Baseline and periodic renal function tests.**
* **Baseline and periodic liver function tests.**
* **Blood pressure.**
* **Signs and symptoms of GI bleeding or ulceration.**
* **Signs and symptoms of cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Caution in patients with pre-existing cardiovascular disease, renal impairment, hepatic impairment, or a history of GI bleeding.
* Avoid concomitant use with other NSAIDs.
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***Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive guidance, as recommendations may vary based on patient-specific factors and evolving medical knowledge.*
