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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for the relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
## Primary Indications
* Osteoarthritis
* Rheumatoid Arthritis
* Ankylosing Spondylitis
## Adult Dosing
* **Osteoarthritis:** 150 mg per day in divided doses (e.g., 50 mg three times daily or 75 mg twice daily). Maximum recommended daily dose is 225 mg.
* **Rheumatoid Arthritis & Ankylosing Spondylitis:** 150 mg to 200 mg per day in divided doses (e.g., 50 mg two to three times daily or 75 mg twice daily). Maximum recommended daily dose is 225 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for oral diclofenac.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider a lower starting dose.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or bleeding.
* Inflammatory bowel disease.
* Established congestive heart failure.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, flatulence, GI bleeding, perforation.
* **Cardiovascular:** Hypertension, edema, increased risk of MI and stroke (especially with long-term use or higher doses).
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Renal:** Renal insufficiency, acute renal failure.
* **Hematologic:** Anemia.
* **Dermatologic:** Rash, pruritus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic effect, increased risk of renal dysfunction.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Blood pressure.
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Electrolytes.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Consider gastroprotective agents (e.g., PPIs) in patients with increased risk of GI events.
* Patients with pre-existing cardiovascular disease or risk factors are at higher risk of adverse cardiovascular events.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details before making clinical decisions.
