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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Management of mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg three times daily, or 75 mg twice daily. Maximum: 225 mg/day.
* **Pain and Primary Dysmenorrhea:** Initial dose of 50 mg, followed by 50 mg every 8 hours as needed. Maximum: 200 mg/day.
## Pediatric Dosing
* **Rheumatoid Arthritis:** Safety and efficacy not established in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Initiate at the lower end of the dosing range. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Initiate at the lower end of the dosing range. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, 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:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatic failure, renal failure, hypertension, fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** Reduced antihypertensive effect, increased risk of renal dysfunction.
* **Diuretics:** Increased risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding.
* Liver function tests (LFTs), especially with long-term use or in patients with pre-existing liver disease.
* Renal function tests (BUN, creatinine), especially in patients with pre-existing renal disease, dehydration, or concomitant use of nephrotoxic agents.
* Blood pressure.
* Signs of fluid retention or edema.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize the risk of serious adverse events.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with cardiovascular risk factors should be closely monitored.
* May mask signs of infection.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a specialist for patient-specific guidance.*
