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# Diclofenac (Oral) ## Overview Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation. ## Primary Indications * Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis. * Mild to moderate pain. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, OR 75 mg orally twice daily. Maximum: 225 mg daily. * **Mild to Moderate Pain:** 50 mg orally every 8-12 hours as needed. Maximum: 150 mg daily. * **Extended-release formulations:** Consult specific product labeling, typically 100 mg once daily or 200 mg once daily. ## Pediatric Dosing * **Rheumatoid Arthritis:** Generally not recommended for children under 12 years of age. For children 12 years and older, 75 mg orally twice daily. Maximum: 225 mg daily. ## 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. Monitor renal function. Avoid in severe renal impairment. ## Contraindications * Hypersensitivity to diclofenac, aspirin, or other NSAIDs. * Active gastrointestinal (GI) ulcer or bleeding. * History of GI ulcer or bleeding with previous NSAID use. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Severe heart failure. * Severe hepatic impairment. * Third trimester of pregnancy. ## Adverse Effects * **Common:** GI upset (nausea, vomiting, diarrhea, constipation), abdominal pain, dyspepsia, headache, dizziness, elevated liver enzymes. * **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding and perforation, renal failure, hepatotoxicity, hypersensitivity reactions, worsening asthma. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI bleeding. * **SSRIs/SNRIs:** Increased risk of GI bleeding. * **Other NSAIDs:** Increased risk of adverse effects. * **ACE inhibitors/ARBs/Diuretics:** May diminish antihypertensive effect and increase risk of renal impairment. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased risk of methotrexate toxicity. ## Monitoring * Signs and symptoms of GI bleeding or ulceration. * Renal function (BUN, creatinine). * Liver function tests (ALT, AST). * Blood pressure. * Signs of cardiovascular events. ## Clinical Pearls * Lowest effective dose for the shortest duration should be used to minimize risks. * Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI events. * Risk of cardiovascular events may increase with duration of use and in patients with risk factors. * Use caution in patients with asthma, as NSAIDs can exacerbate bronchospasm. *** *Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the product label or other authoritative sources before making clinical decisions.*