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**Drug: Diclofenac**
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum dose: 150 mg/day.
* **Acute Pain:** 50 mg orally every 8 hours as needed. Maximum dose: 150 mg/day.
* **Primary Dysmenorrhea:** 50 mg orally at the onset of symptoms, followed by 50 mg every 8 hours as needed. Maximum dose: 150 mg/day.
* **Delayed-release/Enteric-coated:** 50 mg orally two to three times daily, or 75 mg orally twice daily.
* **Extended-release:** 100 mg orally once daily or 75 mg orally twice daily.
* **Topical:** Refer to specific product labeling for application instructions and frequency.
## Pediatric Dosing
* **Pain and Inflammation (Rheumatoid Arthritis):** 1-3 mg/kg/day divided into 2-4 doses. Maximum dose: 150 mg/day. Not recommended for children under 1 year.
* **Other indications:** Dosing varies by indication and age; consult specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment, but monitor renal function closely. Avoid use in severe renal impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment, but monitor liver function closely. Avoid use in severe hepatic impairment.
## Contraindications
* Known 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.
* Advanced renal disease.
* Severe hepatic impairment.
* Inflammatory bowel disease (contraindicated in Crohn's disease and ulcerative colitis).
## Adverse Effects
* **Common:** Gastrointestinal distress (nausea, vomiting, diarrhea, constipation, abdominal pain), dyspepsia, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal failure, hepatotoxicity, hypersensitivity reactions, exacerbation of asthma, 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, Diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Renal function:** Serum creatinine, BUN.
* **Hepatic function:** ALT, AST.
* **Complete blood count (CBC):** Especially if used long-term or in patients with GI bleed risk.
* **Signs and symptoms of GI bleeding or ulceration.**
* **Blood pressure.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Take with food or milk to reduce GI upset.
* Avoid concurrent use with other NSAIDs.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Be aware of increased risk of cardiovascular events, especially with higher doses and prolonged use.
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**Disclaimer:** This information is intended for healthcare professionals and should not be a substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product insert or a reliable drug database.
