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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day divided into 2 or 3 doses. Initial dose is typically 50 mg three times daily or 75 mg two times daily.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Dysmenorrhea:** 50 mg three times daily as needed.
The maximum daily dose for chronic use is 200 mg. For acute pain, the maximum daily dose is 225 mg.
## Pediatric Dosing
Oral diclofenac is generally not recommended for children younger than 12 years. Limited data exists for pediatric use.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but close monitoring is advised. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but close monitoring is advised. Avoid in severe renal impairment.
* **Elderly:** Increased risk of adverse effects. Use the lowest effective dose and monitor closely.
## 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, vomiting, diarrhea, constipation, dyspepsia, flatulence, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## 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:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Renal function:** BUN, serum creatinine.
* **Hepatic function:** ALT, AST.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Cardiovascular risk factors:** Blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Patients with a history of cardiovascular disease or significant risk factors should use diclofenac with caution, if at all.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and your institutional protocols before making clinical decisions.*
