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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Rheumatoid arthritis
* Osteoarthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis:** 50 mg orally two to three times daily, or 75 mg orally two times daily. Maximum total daily dose: 225 mg.
* **Acute pain, Primary dysmenorrhea:** Initial dose 50 mg orally, followed by 50 mg every 8 hours as needed. Do not exceed 200 mg in the first 24 hours.
## Pediatric Dosing
Limited data. Generally not recommended for children under 12 years of age for arthritis. Dosing for children over 12 years for juvenile arthritis is typically 2-3 mg/kg/day divided into 2-4 doses, not to exceed adult maximums.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses.
* **Renal Impairment:** Use with caution, especially in severe impairment. Monitor renal function.
## 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, diarrhea, abdominal pain, headache, dizziness.
Serious: Cardiovascular thrombotic events, myocardial infarction, stroke, gastrointestinal bleeding, ulceration, perforation, renal injury, hepatic injury, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations and toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding.
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Lowest effective dose for shortest duration.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotection (e.g., PPI) in patients with increased risk of GI complications.
* NSAIDs carry a boxed warning for cardiovascular thrombotic events and serious gastrointestinal bleeding.
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**Disclaimer:** This information is for educational purposes only and does not substitute professional medical advice. Always consult with a qualified healthcare provider to verify current prescribing information and for any questions regarding a medical condition or treatment.
