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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.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg daily, divided into 2-3 doses. Maximum dose is 200 mg daily.
* **Mild to moderate pain:** 25 mg every 6-8 hours as needed. Maximum dose is 75 mg per day.
* **Primary Dysmenorrhea:** 50 mg three times daily as needed. Maximum dose is 75 mg per day.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 2-3 mg/kg/day in divided doses. Maximum dose is 200 mg/day. Not recommended for children younger than 1 year.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start at the lower end of the dosing range. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
## Contraindications
* Known 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:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, headache, dizziness, rash, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding/perforation, renal failure, hepatic failure, severe dermatologic reactions (SJS/TEN), anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Other NSAIDs/Aspirin:** Increased risk of GI adverse effects and potential for additive pharmacologic effects.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Blood pressure.
* Cardiovascular risk factors.
## Clinical Pearls
* The lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Administer with food or milk to decrease GI upset.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Consider gastroprotective agents (e.g., PPIs) in patients with increased GI risk.
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_Please verify current prescribing information for complete details and patient-specific considerations._
