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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
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg two to three times daily, or 75 mg twice daily. Maximum daily dose: 225 mg.
* **Acute Pain:** Initial dose 50 mg, followed by 50 mg every 8 hours as needed. Maximum daily dose: 150 mg for the first 2 days.
* **Primary Dysmenorrhea:** Initial dose 50 mg, followed by 50 mg every 8 hours as needed. Maximum daily dose: 200 mg.
## Pediatric Dosing
Dosing for pediatric patients is not well-established and depends on local protocols.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution; avoid in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, dyspepsia, diarrhea), headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatic failure, renal failure, hypersensitivity reactions, Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding and ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Lowest effective dose should be used for the shortest duration necessary.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI events.
* Patients with underlying cardiovascular disease should be carefully assessed before initiating therapy.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines before making clinical decisions.*
