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🔹 Common Indications • Osteoarthritis & rheumatoid arthritis • Acute musculoskeletal pain • Post-operative pain • Dysmenorrhea • Migraine (in some formulations) 🔹 Top Formulations` • Oral tablets (immediate & extended-release) • Topical gels (great for localized pain with fewer systemic effects) • Eye drops (post-cataract surgery inflammation) • Injections (acute severe pain) 🔹 Key Safety Considerations ⚠️ Cardiovascular risk: Increased risk of thrombotic events — use lowest effective dose, shortest duration ⚠️ GI toxicity: Ulcers, bleeding — consider PPIs in high-risk patients ⚠️ Renal impairment: Can reduce renal blood flow — caution in CKD, dehydration, heart failure ⚠️ Hepatotoxicity: Monitor LFTs with long-term use ⚠️ Contraindications: Post-CABG, 3rd trimester pregnancy, aspirin-sensitive asthma 🔹 Drug Interactions to Watch • Anticoagulants (↑ bleeding risk) • ACE inhibitors/ARBs & diuretics (↑ renal risk) • Lithium & methotrexate (↑ toxicity) • Other NSAIDs (additive toxicity) 🔹 Pro Tips for Practice 💡 Topical diclofenac = excellent efficacy with minimal systemic exposure for localized conditions 💡 Always screen for CV and GI risk factors before prescribing 💡 The 200mg/day ceiling is a good rule of thumb for oral dosing 💡 Consider switching to COX-2 selective agents (like celecoxib) in high GI risk, but remember — CV risk still exists 💬 What's your go-to NSAID