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## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Acute pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day, divided into 2 or 3 doses. Maximum daily dose is 200 mg.
* **Acute Pain:** 25 mg to 50 mg every 4 to 6 hours as needed. Maximum daily dose is 150 mg for short-term use.
* **Primary Dysmenorrhea:** 50 mg three times daily as needed. Alternatively, an initial dose of 50 mg, followed by 50 mg every 8 hours as needed, not to exceed 200 mg in 24 hours.
*Note: Dosing for specific formulations (e.g., delayed-release, extended-release, topical) may differ.*
## Pediatric Dosing
* **Rheumatoid Arthritis:** 2 mg/kg/day divided into 2 or 3 doses. Maximum daily dose is 200 mg. Data for children younger than 1 year is limited.
## 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. Monitor renal function, especially in patients with pre-existing renal disease or those at risk for renal complications. May require dose reduction.
* **Elderly:** Increased risk of adverse effects; consider lower doses.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active gastrointestinal bleeding or ulceration.
* History of GI bleeding or perforation related to previous NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe hepatic or renal impairment.
* Late pregnancy (third trimester).
## Adverse Effects
Common: Abdominal pain, nausea, vomiting, diarrhea, dyspepsia, elevated liver enzymes.
Serious: Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal failure, hepatic failure, hypersensitivity reactions, fluid retention, edema, hypertension.
## 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:** Potential for reduced antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Reduced diuretic efficacy and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function (ALT, AST).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Avoid concomitant use with other NSAIDs or salicylates.
* Consider gastroprotection (e.g., PPI) for patients at high risk for GI events.
* Monitor closely for cardiovascular and renal risks, especially in susceptible patients.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always verify current prescribing information and consult relevant guidelines before initiating or modifying therapy.*
