Please check your internet connection and try again.
# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis:** 250 mg as sodium or 200 mg as potassium delayed-release or enteric-coated, taken in divided doses, typically 100 mg twice daily or 125 mg twice daily.
* **Rheumatoid Arthritis and Ankylosing Spondylitis:** 250 mg as sodium or 200 mg as potassium delayed-release or enteric-coated, taken in divided doses, typically 100 mg twice daily or 125 mg twice daily.
* **Acute Pain and Primary Dysmenorrhea:** 500 mg as sodium delayed-release or enteric-coated, taken as a single dose. May repeat after 8 hours if needed, not to exceed 1000 mg in 24 hours.
**Maximum Daily Dose:** Generally 200 mg daily for chronic conditions. For acute pain, up to 1000 mg in 24 hours.
## Pediatric Dosing
Efficacy and safety in pediatric patients have not been established for oral diclofenac.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Data is limited, but consider lower doses or avoidance in severe impairment.
* **Renal Impairment:** Use with caution. NSAIDs can impair renal function. Consider lower doses or avoidance 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, elevated liver enzymes, peptic ulceration, bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and thrombosis.
* **Renal:** Renal insufficiency, acute renal failure.
* **Other:** Headache, dizziness, rash.
## Key Drug Interactions
* **ACE Inhibitors/ARBs:** Increased risk of renal impairment and reduced antihypertensive effect.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Renal function:** Baseline and periodically, especially in patients with risk factors for renal impairment.
* **Liver function:** Baseline and periodically, especially in patients with pre-existing liver disease.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of GI bleeding:** Monitor for hematemesis, melena, or occult blood in stool.
* **Signs of cardiovascular events:** Monitor for chest pain, shortness of breath, weakness.
## Clinical Pearls
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Avoid concomitant use with other NSAIDs.
* Dosing regimens vary based on the formulation (delayed-release vs. enteric-coated).
***
*Please consult the most current prescribing information and relevant clinical guidelines for definitive dosing and management strategies.*
