Tab%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520diclofenac

## Tab diclofenac ### Overview Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation. ### Primary Indications * Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. * Mild to moderate pain. * Acute gouty arthritis. ### Adult Dosing * **Osteoarthritis:** 25 mg three times daily or 50 mg twice daily. Maximum daily dose: 75 mg. * **Rheumatoid Arthritis, Ankylosing Spondylitis:** 25 mg four times daily or 50 mg twice daily. Maximum daily dose: 100 mg. * **Acute Pain:** 25 mg every 6-8 hours as needed. Maximum daily dose: 75 mg. * **Acute Gouty Arthritis:** 50 mg three times daily for 3 days, then 25 mg three times daily for 3-6 days. Maximum daily dose: 150 mg. ### Pediatric Dosing Dosing in pediatric patients is not well established for oral diclofenac. Consult specific pediatric guidelines or literature. ### Dose Adjustments * **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but monitor closely. Avoid in severe hepatic impairment. * **Renal Impairment:** Use with caution. Consider reduced doses in patients with significant renal impairment, but data are limited. Monitor renal function closely. ### 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: Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness. Serious: Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, hepatic failure, renal 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. * **Other NSAIDs (including aspirin):** Increased risk of GI toxicity and other adverse effects. * **ACE inhibitors, Angiotensin II Receptor Blockers (ARBs):** May reduce antihypertensive effect and increase risk of renal impairment. * **Diuretics:** May reduce diuretic efficacy and increase risk of renal impairment. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased methotrexate levels and toxicity. ### Monitoring * Signs and symptoms of GI bleeding or ulceration. * Liver function tests (LFTs), especially with long-term use or in patients with pre-existing liver disease. * Renal function tests (creatinine, BUN). * Blood pressure. * Signs and symptoms of cardiovascular events. ### Clinical Pearls * Use the lowest effective dose for the shortest duration necessary. * Administer with food or milk to minimize GI upset. * Be aware of increased cardiovascular and GI risks, especially in elderly patients or those with risk factors. * Avoid concurrent use with other NSAIDs. Please consult the current prescribing information for the most up-to-date and comprehensive drug information.