Tab%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520diclofenac

# Diclofenac ## Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. ## Primary Indications * Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis) * Mild to moderate pain (e.g., acute pain, dysmenorrhea, post-operative pain) ## Adult Dosing * **Oral:** * **Immediate-release:** 25 mg to 50 mg three to four times daily. Maximum daily dose: 200 mg. * **Delayed-release:** 25 mg to 75 mg two to three times daily. Maximum daily dose: 225 mg. * **Extended-release:** 75 mg to 100 mg once daily. Maximum daily dose: 100 mg. * **Topical:** * **Gel/Patch:** Apply to affected area as directed by product labeling (e.g., 1% gel 4 times daily, 3% gel twice daily, patch every 12 or 24 hours). ## Pediatric Dosing Dosing in pediatric patients is not well-established for oral formulations and should be based on weight and clinical judgment. Topical formulations may be used in adolescents based on product labeling. ## Dose Adjustments * **Renal Impairment:** Use with caution. Consider dose reduction in severe impairment. * **Hepatic Impairment:** Use with caution. Consider dose reduction in mild to moderate impairment; avoid 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. * Third trimester of pregnancy. ## Adverse Effects * **Common:** Gastrointestinal upset (dyspepsia, nausea, diarrhea), dizziness, headache. * **Serious:** Increased risk of cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic injury, hypersensitivity reactions, Stevens-Johnson syndrome. ## 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:** May diminish antihypertensive effects; increased risk of renal dysfunction. * **Diuretics:** Increased risk of renal dysfunction. * **Lithium:** Increased risk of lithium toxicity. * **Methotrexate:** Increased risk of methotrexate toxicity. ## Monitoring * Signs and symptoms of GI bleeding or ulceration. * Renal function (BUN, creatinine). * Liver function tests (ALT, AST). * Blood pressure. * Signs of cardiovascular events. ## Clinical Pearls * Lowest effective dose for the shortest duration should be used to minimize risks. * Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications. * Avoid concurrent use with other NSAIDs. * Topical diclofenac may offer a lower systemic absorption and potentially reduced systemic side effects compared to oral formulations for localized pain. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and a qualified healthcare professional for any medical decisions or treatment. Local protocols and guidelines may influence specific dosing recommendations.*