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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum dose: 225 mg/day.
* **Acute Pain:** 50 mg orally every 6 to 8 hours as needed. Maximum dose: 150 mg/day.
* **Primary Dysmenorrhea:** 50 mg orally three times daily as needed. Maximum dose: 150 mg/day.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for most indications. Specific protocols may exist for certain conditions.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be considered in severe impairment, though specific guidelines are lacking. Monitor renal function closely.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in mild to moderate impairment. Contraindicated in severe hepatic impairment. Monitor liver function closely.
## 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.
* Concurrent use with other NSAIDs.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, elevated liver enzymes.
* **Serious:** Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatotoxicity, hypersensitivity reactions, exacerbation of hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
## Monitoring
* Baseline and periodic assessment of renal function (BUN, creatinine).
* Baseline and periodic assessment of liver function (ALT, AST).
* Monitor for signs and symptoms of GI bleeding or perforation.
* Monitor for signs and symptoms of cardiovascular events.
* Monitor blood pressure, especially in patients with hypertension.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risk.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI bleeding.
* Avoid in patients with established atherosclerotic cardiovascular disease or risk factors for it, unless benefits clearly outweigh risks.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines for complete details before making any clinical decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
