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## Diclofenac
### 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.
* Management of acute pain.
* Primary dysmenorrhea.
### Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150-200 mg per day in 3-4 divided doses. Extended-release formulations: 100-200 mg once daily.
* **Acute Pain:** 50 mg every 8 hours as needed.
* **Primary Dysmenorrhea:** 50 mg every 8 hours as needed, or a single 100 mg dose, followed by 50 mg doses if needed. Maximum 200 mg on the first day.
### Pediatric Dosing
* **Rheumatoid Arthritis:** 1-3 mg/kg/day in 2-4 divided doses. Maximum 200 mg/day. Use in children under 14 years of age is generally not recommended due to limited data and potential for toxicity.
### Dose Adjustments
* **Hepatic Impairment:** Use with caution. Starting dose reduction may be considered.
* **Renal Impairment:** Use with caution. Monitor renal function closely.
### 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.
### Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, elevated liver enzymes.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), renal toxicity, anaphylaxis, hepatic failure.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** 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 and increased risk of renal dysfunction.
* **Lithium/Methotrexate:** Increased serum levels and toxicity.
### Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST).
* Blood pressure.
* Signs of cardiovascular events.
### Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs.
* Prescribe with a proton pump inhibitor (PPI) or H2 blocker for patients at increased risk of GI complications.
* Consider cardiovascular risk factors before initiating therapy.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and your institution's protocols for complete details and to ensure the most up-to-date and appropriate treatment decisions.*
