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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for the management of pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, or 75 mg orally twice daily. Maximum: 225 mg/day.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Maximum: 150 mg/day.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum: 150 mg/day.
* **Extended-Release Formulations:** Varies by product, typically 100 mg to 200 mg once daily.
## Pediatric Dosing
* **Pain and Inflammation (e.g., Juvenile Idiopathic Arthritis):** 1-3 mg/kg/day orally divided into 2-3 doses. Maximum: 150 mg/day. Specific dosing often depends on local protocol and product availability.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower initial dose.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Dosing adjustment may be necessary 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
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation), abdominal pain, dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal impairment, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease diclofenac's cardioprotective effects and increase risk of GI bleeding.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Diuretics:** Reduced diuretic efficacy and increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs:** Additive toxicity, increased risk of adverse effects.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Blood pressure.
* Signs and symptoms of cardiovascular events.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risk.
* Administer with food or milk to reduce gastrointestinal upset.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution.
* Avoid concurrent use with other NSAIDs.
* Monitor for signs of hepatic or renal toxicity, especially in elderly patients or those with pre-existing organ dysfunction.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant clinical guidelines before making treatment decisions.*
