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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* Immediate-release: 50 mg three times daily or 75 mg twice daily.
* Delayed-release: 75 mg twice daily.
* **Mild to moderate pain:**
* Immediate-release: 50 mg every 8 hours as needed.
* **Maximum Daily Dose:** 225 mg (delayed-release) or 150 mg (immediate-release).
## Pediatric Dosing
* Dosing is not established for children under 12 years of age for most indications.
* For juvenile rheumatoid arthritis in patients 12 years and older, doses are similar to adults but depend on body weight and clinical response. Consult specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment, but monitor renal function. Avoid if severe renal impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment, but monitor liver function. Avoid if severe hepatic impairment.
## 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 (dyspepsia, nausea, diarrhea), dizziness, headache.
* **Serious:**
* Cardiovascular thrombotic events (myocardial infarction, stroke).
* Gastrointestinal perforation, ulceration, and bleeding.
* Hepatotoxicity.
* Renal toxicity.
* Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis).
* Fluid retention and edema.
## Key Drug Interactions
* **ACE Inhibitors, ARBs, Diuretics:** Increased risk of renal impairment.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs:** Additive toxicity, increased risk of adverse effects.
## Monitoring
* Baseline and periodic liver function tests (LFTs).
* Baseline and periodic renal function tests (e.g., creatinine, BUN).
* Monitor for signs and symptoms of GI bleeding or perforation.
* Monitor for signs and symptoms of cardiovascular events.
* Monitor blood pressure.
## Clinical Pearls
* Consider the lowest effective dose for the shortest duration necessary to minimize GI and cardiovascular risks.
* Co-administration with a proton pump inhibitor (PPI) or misoprostol may be considered in patients at increased risk for GI complications.
* Patients with pre-existing cardiovascular disease or risk factors are at higher risk for serious cardiovascular thrombotic events.
* Discontinue at the first sign of rash or allergic reaction.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and professional guidelines before making clinical decisions.*
