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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain relief
* Inflammation associated with conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
## Adult Dosing
* **Immediate-release:** 50 mg orally two to three times daily. Maximum daily dose: 200 mg.
* **Delayed-release/Enteric-coated:** 75 mg orally twice daily. Maximum daily dose: 150 mg.
* **Extended-release:** 100 mg orally once daily. Can be increased to 200 mg once daily if needed.
Dosing for acute pain may differ and should be guided by local protocols.
## Pediatric Dosing
* **Rheumatic diseases:** 2-3 mg/kg/day divided into 2-4 doses. Maximum daily dose: 100 mg.
* **Acute pain/dysmenorrhea:** 50 mg orally once, followed by 25-50 mg every 8 hours as needed. Maximum daily dose: 150 mg.
Use in children under 16 years should be under strict medical supervision.
## Dose Adjustments
* **Hepatic impairment:** Use with caution. Consider lower doses.
* **Renal impairment:** Use with caution. Monitor renal function.
## 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.
* Severe hepatic or renal impairment.
* Active gastrointestinal bleeding.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke. Hypertension. Fluid retention and edema.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus.
## 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:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding.
* Blood pressure.
* Renal and hepatic function (especially in patients with pre-existing impairment or on long-term therapy).
* Electrolytes.
## 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 concurrent use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
