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## 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 to 200 mg per day in divided doses. Maximum daily dose is 225 mg. * **Mild to Moderate Pain/Primary Dysmenorrhea:** * Initial dose: 50 mg three times daily as needed. * Or: 100 mg as a single initial dose, followed by 50 mg doses as needed. * Maximum daily dose: 200 mg. ## Pediatric Dosing Dosing for children is not well-established and depends on the specific formulation and indication. Consult pediatric-specific resources. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Lower doses may be warranted. * **Renal Impairment:** Use with caution. Monitor renal function closely. ## 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: Gastrointestinal upset, nausea, diarrhea, headache, dizziness. Serious: Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatic injury, hypersensitivity reactions. ## 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 effect, increased risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. ## Monitoring * **GI Bleeding/Ulceration:** Monitor for signs and symptoms. * **Cardiovascular Risk:** Assess baseline and ongoing risk factors. * **Renal Function:** Monitor BUN, creatinine, especially in patients with risk factors. * **Hepatic Function:** Monitor LFTs, especially with prolonged use or pre-existing liver disease. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce gastrointestinal upset. * Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications. * Be aware of the increased cardiovascular and GI risks associated with NSAIDs. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details before making any clinical decisions.*