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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain (mild to moderate)
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Dysmenorrhea
## Adult Dosing
* **Pain:** 25 mg to 50 mg orally every 8 hours as needed. Maximum daily dose: 150 mg.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2 to 3 times daily. Alternatively, 75 mg orally twice daily. Maximum daily dose: 150 mg.
* **Dysmenorrhea:** 25 mg to 50 mg orally every 8 hours as needed. Start dose at the onset of pain. Maximum daily dose: 150 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well-established for all indications and formulations. Consult specific pediatric guidelines or literature for appropriate use.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Initiate at the lower end of the dosage range.
* **Renal Impairment:** Use with caution. 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 adverse effects include gastrointestinal upset (nausea, dyspepsia, diarrhea, constipation), dizziness, headache, and rash. Serious adverse effects include cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatic failure, and hypersensitivity reactions.
## 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.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **GI Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis).
* **Cardiovascular Risk:** Assess risk factors and monitor for signs of MI or stroke.
* **Renal Function:** Monitor BUN, creatinine, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor LFTs, especially with prolonged use or in patients with hepatic impairment.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications.
* Avoid concurrent use with other NSAIDs.
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*This information is for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information and guidelines with a healthcare professional.*
