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## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
* Mild to moderate pain.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. The maximum daily dose is 225 mg.
* **Mild to moderate pain:** 25 mg orally every 4 to 6 hours as needed. The maximum daily dose is 100 mg. Some formulations may allow up to 150 mg daily for short-term treatment of acute pain, but this is not standard for all products.
## Pediatric Dosing
Limited data for oral diclofenac in pediatric patients. Topical diclofenac gel (e.g., 1%) is approved for osteoarthritis in patients 12 years and older at doses varying by location and surface area. Consult specific product information for topical diclofenac pediatric dosing.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses.
* **Renal Impairment:** Use with caution. Monitor renal function.
* **Elderly:** Increased risk of gastrointestinal bleeding, renal, and cardiovascular events. Consider lower doses and shortest duration of therapy.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* Active gastrointestinal bleeding or ulceration.
* History of GI bleeding or perforation related to prior NSAID use.
* Coronary artery bypass graft (CABG) surgery.
* Late pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, diarrhea, headache, dizziness.
* **Serious:** Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal failure, hepatotoxicity, hypertension, edema, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** May reduce antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** May reduce diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding.
* Renal function (serum creatinine, BUN).
* Liver function (ALT, AST).
* Blood pressure.
* Signs of fluid retention.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Concurrent use with other NSAIDs, aspirin, corticosteroids, or anticoagulants significantly increases bleeding risk.
* Consider gastroprotective agents (e.g., PPIs) in patients with increased GI risk factors.
* Discontinue immediately if signs of hepatotoxicity or cardiovascular events occur.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines or local protocols.*
