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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg per day, divided into 2-4 doses. Doses of 50 mg three times daily are also used.
* **Mild to moderate pain:** 50 mg every 8-12 hours as needed. Extended-release formulations may be dosed once or twice daily.
**Maximum Dose:** Generally, do not exceed 200 mg per day.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Children 1 year and older: 1-3 mg/kg/day in divided doses. Maximum daily dose 200 mg.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is usually recommended, but monitor for adverse effects.
* **Renal Impairment:** Use with caution. No specific dose adjustment is usually recommended, but monitor for adverse effects.
## 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
* **Common:** Abdominal pain, nausea, vomiting, diarrhea, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hypertension, edema, fluid retention, renal toxicity, hepatic toxicity, severe skin reactions (e.g., Stevens-Johnson syndrome), anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive efficacy and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs, Aspirin:** Increased risk of adverse effects, especially GI bleeding.
## Monitoring
* **Baseline and periodic:** Renal function (serum creatinine, BUN), liver function (ALT, AST), hemoglobin/hematocrit.
* **During therapy:** 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.
* Consider risk factors for GI bleeding (age, history of ulcer, concomitant medications like corticosteroids or anticoagulants).
* NSAIDs can increase the risk of serious cardiovascular thrombotic events. Patients with known cardiovascular disease may be at higher risk.
* Concurrent use with aspirin for cardioprotection should be done cautiously, as diclofenac may interfere with aspirin's antiplatelet effect. If co-administration is necessary, consider spacing doses of diclofenac and aspirin.
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*Disclaimer: This information is intended for clinical use and does not substitute for professional medical judgment. Always consult current prescribing information and institutional protocols for the most up-to-date and comprehensive details.*
