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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

Consider physical therapy earlier if you have recurring episodes or significant weakness

Mechanisms of ascorbic acid recycling in human erythrocytes