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# Diclofenac (Oral Tablet)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, OR 75 mg orally twice daily. Maximum recommended daily dose is 225 mg.
* **Pain:** 25 mg orally every 6 to 8 hours as needed. Maximum recommended daily dose is 75 mg.
* Some extended-release formulations exist; follow specific product labeling.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and generally not recommended due to safety concerns, particularly the risk of gastrointestinal and cardiovascular adverse events.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider starting at the lower end of the dosing range. Severe hepatic impairment is a contraindication.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Dose reduction may be necessary in severe impairment, though specific guidelines vary.
## 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.
* Active gastrointestinal (GI) bleeding or perforation.
* Inflammatory bowel disease (active).
* Severe heart failure.
* Severe hepatic impairment.
* Severe renal impairment (CrCl < 30 mL/min).
* Pregnancy (third trimester).
## Adverse Effects
Common adverse effects include: GI upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, headache, dizziness, rash. Serious adverse effects include: GI bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatic toxicity, fluid retention, hypertension, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) & Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs:** Additive toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor blood pressure.
* Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function (AST, ALT) especially with long-term use or in patients with liver disease.
* Assess pain and inflammation control.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider concomitant gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Patients with cardiovascular risk factors should use diclofenac with caution and only if clearly indicated.
* Discontinue if any signs of hepatic or renal dysfunction arise.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines before making any treatment decisions.
