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# Diclofenac
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis/Rheumatoid Arthritis/Ankylosing Spondylitis:** 50 mg orally twice daily or 75 mg orally twice daily. Maximum dose: 225 mg/day.
* **Acute Pain/Primary Dysmenorrhea:**
* Initial dose: 50 mg orally three times daily.
* Subsequent doses: 50 mg orally every 8 hours as needed.
* Maximum dose: 200 mg/day.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 2-12 years: 1-3 mg/kg/day in divided doses. Do not exceed adult doses.
* **Analgesia/Dysmenorrhea:** Safety and efficacy in children under 16 years for these indications have not been established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction.
* **Renal Impairment:** Use with caution. Monitor renal function. Dose reduction may be necessary.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Use in patients with active inflammatory bowel disease.
* Use in advanced renal disease.
## Adverse Effects
* **Common:** Gastrointestinal upset, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal perforation, ulceration, bleeding, hypertension, fluid retention, edema, renal toxicity, hepatotoxicity, severe skin reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs)/Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **Diuretics/ACE inhibitors/ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (ALT, AST)
* Blood pressure
* Signs and symptoms of gastrointestinal bleeding
* Signs and symptoms of cardiovascular events
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotective agents (e.g., PPIs) for patients at increased risk of GI complications.
* Cardiovascular and gastrointestinal risks increase with duration of use and higher doses.
**Disclaimer:** This information is intended for healthcare professionals and does not replace professional medical advice. Always consult the most current prescribing information and clinical guidelines for complete details before making any treatment decisions.
