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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.
* Mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Immediate-release: 150 mg/day divided into 3-4 doses. Maximum: 225 mg/day.
* Delayed-release: 75 mg twice daily or 100 mg once daily. Maximum: 225 mg/day.
* Extended-release: 100 mg to 200 mg once daily. Maximum: 200 mg/day.
* **Mild to Moderate Pain:**
* Immediate-release: 50 mg every 8 hours as needed. Maximum: 150 mg/day.
## Pediatric Dosing
* **Juvenile Idiopathic Arthritis:**
* 1-12 years: 1 mg/kg/day divided into 2-4 doses. Maximum: 3 mg/kg/day or 150 mg/day, whichever is less.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; consider lower doses. Avoid if severe hepatic impairment.
* **Renal Impairment:** Use with caution; monitor renal function. Avoid if severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or perforation.
## Adverse Effects
* **Common:** GI upset (dyspepsia, nausea, diarrhea), dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding, perforation, ulceration, hepatotoxicity, nephrotoxicity, hypersensitivity reactions, fluid retention, edema, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** 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.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Complete blood count (CBC) for signs of anemia or GI bleeding.
* Blood pressure.
* Signs and symptoms of GI bleeding or ulceration.
## Clinical Pearls
* Lowest effective dose for the shortest duration should be used.
* Concurrent use with other NSAIDs or aspirin increases the risk of GI adverse events.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Administer with food or milk to minimize GI upset.
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*Please verify current prescribing information and consult with a healthcare professional for individualized medical advice.*
