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## Diclofenac
### Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of pain and inflammation.
### Primary Indications
* Pain and inflammation associated with osteoarthritis
* Pain and inflammation associated with rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
### Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum daily dose: 225 mg.
* **Acute Pain:** 50 mg orally every 4 to 6 hours as needed. Maximum daily dose: 200 mg.
* **Enteric-coated tablets:** Usually taken with food.
* **Delayed-release tablets:** Usually taken with food.
* **Extended-release tablets:** 100 mg orally once daily. Maximum daily dose: 100 mg.
### Pediatric Dosing
* **Rheumatoid Arthritis:** 1 to 3 mg/kg/day orally divided into 2 to 4 doses. Maximum daily dose: 200 mg. Dosing for children under 1 year of age is not established.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Data are limited, but dose reduction may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. Start with a lower dose and monitor liver function closely.
### Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
* Severe hepatic or renal impairment.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
### Adverse Effects
* **Common:** Dyspepsia, abdominal pain, nausea, diarrhea, constipation, headache, dizziness, rash.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Gastrointestinal:** Serious GI bleeding, ulceration, and perforation.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Hypersensitivity:** Anaphylaxis, bronchospasm.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect; increased risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
### Monitoring
* **Renal function:** BUN, creatinine.
* **Hepatic function:** AST, ALT, bilirubin.
* **Complete blood count (CBC):** For signs of anemia or bleeding.
* **Blood pressure:** Monitor for hypertension.
* **Signs and symptoms of GI bleeding.**
### Clinical Pearls
* The lowest effective dose should be used for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) for patients at increased risk of GI complications.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with extreme caution.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.*
