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## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation.
## Primary Indications
* Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and other musculoskeletal conditions.
* Acute pain management (e.g., post-operative pain, dysmenorrhea).
## Adult Dosing
* **Osteoarthritis/Rheumatoid Arthritis:** 150-200 mg per day divided into 2-4 doses. Maximum dose: 200 mg/day. Extended-release formulations may be dosed once or twice daily.
* **Acute Pain/Dysmenorrhea:** 50 mg three times daily as needed, or a single dose of 100 mg followed by 50 mg doses if needed. Maximum dose: 200 mg/day.
* **Post-operative Pain:** 100 mg loading dose, followed by 50 mg every 8 hours as needed. Maximum dose: 200 mg/day.
Dosing for specific formulations (e.g., extended-release, topical, ophthalmic) will vary. Always consult product-specific information.
## Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg per day divided into 2-4 doses. Maximum dose: 200 mg/day.
Limited data exists for other indications in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or GI bleeding.
* Inflammatory bowel disease.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), GI bleeding/perforation, renal failure, hepatic failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **ACE inhibitors/ARBs:** Increased risk of renal impairment.
* **Diuretics:** Decreased diuretic efficacy and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and other adverse effects.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Warfarin/Anticoagulants:** Increased risk of bleeding.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Hemoglobin and hematocrit (for signs of GI bleeding).
* Blood pressure.
* Signs and symptoms of cardiovascular events.
* Signs and symptoms of GI bleeding or ulceration.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Monitor for signs of fluid retention and edema, especially in patients with cardiovascular disease or hypertension.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI bleeding.
* Avoid in patients with a history of NSAID-induced asthma.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Local protocols may influence specific dosing and management.
