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# Diclofenac (Oral) ## Overview Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation management. ## Primary Indications * Pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. * Mild to moderate pain. * Migraine headache. ## Adult Dosing * **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally 2 to 3 times daily, or 75 mg orally twice daily. Extended-release formulations: 100 mg orally once daily. Maximum daily dose: 225 mg. * **Mild to Moderate Pain:** 50 mg orally every 8 hours as needed. Maximum daily dose: 225 mg. * **Migraine Headache:** 100 mg orally as a single dose. May repeat once after 2 hours if response is inadequate. Do not exceed 200 mg in 24 hours. ## Pediatric Dosing Dosing in pediatric patients is not well-established for all indications and formulations. Specific recommendations should be based on available product labeling or expert consultation. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but close monitoring is recommended. Avoid use in severe hepatic impairment. * **Renal Impairment:** Use with caution. Dose reduction may be considered in patients with severe renal impairment, but specific guidelines are not universally established. Monitor renal function closely. ## Contraindications * Known hypersensitivity to diclofenac, aspirin, or other NSAIDs. * History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Active gastrointestinal bleeding or ulceration. ## Adverse Effects Common: Dyspepsia, abdominal pain, nausea, elevated liver enzymes, headache, dizziness, rash. Serious: Gastrointestinal bleeding and perforation, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatic failure, Stevens-Johnson syndrome, anaphylaxis. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI bleeding. * **ACE inhibitors, ARBs, diuretics:** May reduce antihypertensive effects and increase risk of renal impairment. * **Lithium, Methotrexate:** Diclofenac can increase serum concentrations. * **Other NSAIDs/Aspirin:** Increased risk of GI and other adverse effects. ## Monitoring * Signs and symptoms of GI bleeding or ulceration. * Liver function tests (ALT, AST), especially with chronic use or in patients with pre-existing liver disease. * Renal function (BUN, creatinine), especially in patients with renal impairment or at risk for renal toxicity. * Blood pressure. * Signs and symptoms of cardiovascular events. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary. * Consider gastroprotection (e.g., PPI) for patients at increased risk of GI events. * Caution in elderly patients and those with cardiovascular disease, heart failure, hypertension, or renal impairment. * Avoid concurrent use with other NSAIDs. --- *This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition and to review the most current prescribing information.*