Diclofenac and Misoprostol (Oral)

Diclofenac and misoprostol relieves pain from osteoarthritis and rheumatoid arthritis.

Overview

The diclofenac and misoprostol combination relieves swelling, stiffness, tenderness, and pain that osteoarthritis and rheumatoid arthritis causes. Osteoarthritis is triggered due to joint lining breaking down, and rheumatoid arthritis is initiated by joint lining swelling for people who are at a higher risk of getting stomach ulcers. This medication works by preventing ulcers by defending the lining of the stomach and lowering the production of stomach acid. It also inhibits the production of substances that instigate inflammation and pain.

This medication can only be acquired with a prescription from your physician. It is currently available in tablet and enteric-coated tablet form. It is manufactured under the US brand name Arthrotec.

Conditions treated

  • Osteoarthritis
  • Rheumatoid arthritis

Type of medicine

  • Nonsteroidal Antiinflammatory Drugs

Side Effects

In addition to the positive benefits, medications can also trigger side effects that can be unfavorable. While it is not typical for many side effects to take place, if one or more do happen they may warrant medical care. Consult with your physician right away if you experience the subsequent side effects.

Less Common Side Effects (Medical Care Required)

  • Stools that are tarry (black)
  • Red spots or bruises on skin
  • Chest pain
  • Chills
  • Confusion
  • Thirst (prolonged)
  • Seizures (convulsions)
  • Hoarseness or cough
  • Drowsiness
  • Disorientation
  • Fainting
  • Retaining fluid
  • Illness (sensation of)
  • Indigestion or heartburn
  • Heart rate quickened
  • Weight gain increased
  • Fever without or with chills
  • Heartbeat irregularity
  • Skin itching
  • Dizziness or lightheadedness
  • Side pain or lower back pain
  • Mental depression
  • Muscular cramps
  • Nausea
  • Urination difficulty (painful)
  • Psychotic reaction
  • Rectal bleeding
  • Serious headache
  • Perceptions of things that aren't actually there
  • Rectal bleeding
  • Heartbeat pounding
  • Skin patches (purplish, blue, flat, and large)
  • Headache (serious)
  • Liver reactions (severe)
  • Stomach burning, cramping, or pain
  • Sore throat
  • Skin rash
  • White spots, ulcers, or sores in mouth or on lips
  • Stiff back or neck
  • Urine decrease (abrupt)
  • Upper stomach tenderness or swelling
  • Swelling of the lower legs, feet, fingers, or face
  • Difficulty breathing, chest tightness
  • Bruising or bleeding (unusual)
  • Weakness or tiredness (unusual)
  • Skin or eye yellowing
  • Vomiting odd textured substances resembling coffee grounds
  • Sores on lips (crusting or bleeding)
  • Blood within stools or urine

Rare Side Effects (Medical Care Required)

  • Skin color (facial) changing
  • Eyelid swelling or puffiness near the eye
  • Breathing irregularities (or quick)

Occasionally, patients could experience various side effects that may not typically require medical attention. As your body becomes more accustomed to the prescription, any side effects that are revealed could potentially disappear over the course of treatment. In addition, your physician can inform you of ways to reduce or prevent certain side effects. Consult with your medical care professional if you have questions or concerns regarding the following the following side effects, or if they become prolonged or are troublesome.

More Common Side Effects (Medical Care Not Required)

  • Gas

Less Common Side Effects (Medical Care Not Required)

  • Taste sensations change
  • Vision abnormalities
  • Appetite decrease
  • Sexual activity decline
  • Mouth dryness
  • Hair loss
  • Nervousness or irritability
  • Muscle pain
  • Prickling, burning, or tingling sensations
  • Swallowing difficulty
  • Bleeding (vaginal)
  • Acne

Patients may also experience other side effects that are not included here. If other side effects are observed, consult with your medical care professional.

Dosage

Patients should never take more of this medication than prescribed. It should never be taken more frequently, or fore a longer duration than your physician ordered. Too much of the diclofenac and misoprostol combination could raise the likelihood of undesired side effects. Make sure you consult with your physician prior to changing the dosage or ending use of this medication.

Diclofenac and misoprostol will be packaged with a medication overview guide and an informational patient booklet. Follow all instructions cautiously. Direct any questions you may have to your physician.

This medication must not be combined with antacids that contain magnesium. Antacids without magnesium can aid with stomach pain and can be taken with this medication as required, unless otherwise instructed by your physician. Antacids that contain magnesium could trigger diarrhea or intensify conditions of diarrhea that this medication occasionally causes.

Never share this medication with another individual who has not yet been seen by a doctor.

Take this medication with meals, and ensure you are swallowing the entire table whole. Never dissolve, crush, or chew it.

Oral Dosage Information (Tablet Form)

Patients will receive different doses of this medication according to the medical issue they have for which they need the medication. Always follow your physician's instructions carefully, or the package label instructions by the pharmacist. The information below only covers average doses of the diclofenac and misoprostol combination. If you have been prescribed a dose that varies from the following information, do not adjust your dosage unless instructed by your physician.

For Osteoarthritis Relief

  • Adults: Take one capsule (Arthrotec 50) at three different times per day. Your physician may change the dose as required.
  • Children: Physician must determine dose.

For Rheumatoid Arthritis Relief

  • Adults: Take one capsule (Arthrotec 50) three or four different times per day. Your physician may change the dose as required.
  • Children: Physician must determine dose.

Lower Doses for Osteoarthritis or Rheumatoid Arthritis Relief

  • Adults: Take one capsule (Arthrotec 50) twice daily, or one capsule (Arthrotec 75) twice daily. Your physician may change the dose as required.
  • Children: Physician must determine dose.

Missed Dose

Patients who accidentally miss a dose should take it right away. However, if it is nearer in the schedule for the next dose, the skipped dose may remain missed and the former normal dosing schedule should be resumed. Never take a double dose of diclofenac and misoprostol.

Overdose

Seek emergency medical care right away if you experience any of the subsequent signs of overdose.

Signs of Overdose

  • Fever
  • Diarrhea
  • Heartbeat slowed
  • Stomach pain
  • Shaking or trembling

Interactions

Drug Interactions

In some circumstances, medications should not ever be combined and used at the same time, however other circumstances may warrant the combination despite the potential interaction that may take place. Your physician may adjust the dosage amount for either medication, or they may aim to take other types of precautions for your protection. While on this medication, it is imperative your medical care professional is aware if you are currently already taking any of the following prescription drugs. The list below includes medications that could have a potentially significant interaction with diclofenac and misoprostol, and this list is not completely all-inclusive.

It is not normally suggested to take the following medication with diclofenac and misoprostol. Your physician could choose to prescribe an alternate medication, or could adjust other drugs that you are currently taking.

  • Ketorolac

It is not normally suggested to take the following medications with diclofenac and misoprostol, but certain instances may require the combination. When both medications are prescribed at the same time, your physician will likely reduce the frequency or dosage amount for both or just one of the medications.

  • Xipamide
  • Warfarin
  • Vortioxetine
  • Vorapaxar
  • Vilazodone
  • Venlafaxine
  • Valdecoxib
  • Trolamine Salicylate
  • Trimipramine
  • Trichlormethiazide
  • Triamterene
  • Treprostinil
  • Torsemide
  • Tolmetin
  • Tolfenamic Acid
  • Tirofiban
  • Tinzaparin
  • Ticlopidine
  • Ticagrelor
  • Tiaprofenic Acid
  • Tianeptine
  • Tenoxicam
  • Tacrolimus
  • Sulindac
  • Sulfasalazine
  • Spironolactone
  • Sodium Salicylate
  • Sibutramine
  • Sertraline
  • Salsalate
  • Salicylic Acid
  • Salicylamide
  • Rofecoxib
  • Rivaroxaban
  • Reviparin
  • Reboxetine
  • Protriptyline
  • Protein C
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Prednisone
  • Prednisolone
  • Prasugrel
  • Pralatrexate
  • Polythiazide
  • Piroxicam
  • Piketoprofen
  • Phenylbutazone
  • Phenyl Salicylate
  • Phenprocoumon
  • Phenindione
  • Pentoxifylline
  • Pentosan Polysulfate Sodium
  • Pemetrexed
  • Paroxetine
  • Parnaparin
  • Parecoxib
  • Paramethasone
  • Oxyphenbutazone
  • Oxaprozin
  • Opipramol
  • Olsalazine
  • Nortriptyline
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Nefazodone
  • Naproxen
  • Nadroparin
  • Nabumetone
  • Morniflumate
  • Milnacipran
  • Metolazone
  • Methylprednisolone
  • Methyclothiazide
  • Methotrexate
  • Mesalamine
  • Meloxicam
  • Melitracen
  • Mefenamic Acid
  • Meclofenamate
  • Meadowsweet
  • Magnesium Salicylate
  • Lumiracoxib
  • Loxoprofen
  • Lornoxicam
  • Lofepramine
  • Lithium
  • Levomilnacipran
  • Lepirudin
  • Ketoprofen
  • Indapamide
  • Imipramine
  • Iloprost
  • Ibuprofen
  • Hydroflumethiazide
  • Hydrocortisone
  • Hydrochlorothiazide
  • Heparin
  • Gossypol
  • Ginkgo
  • Furosemide
  • Fondaparinux
  • Fluvoxamine
  • Flurbiprofen
  • Fluoxetine
  • Fluocortolone
  • Flufenamic Acid
  • Floctafenine
  • Feverfew
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Ethacrynic Acid
  • Escitalopram
  • Eptifibatide
  • Epoprostenol
  • Eplerenone
  • Enoxaparin
  • Edoxaban
  • Duloxetine
  • Droxicam
  • Doxepin
  • Dothiepin
  • Dipyrone
  • Dipyridamole
  • Digoxin
  • Diflunisal
  • Diclofenac
  • Dibenzepin
  • Diazoxide
  • Dexketoprofen
  • Dexibuprofen
  • Dexamethasone
  • Desvenlafaxine
  • Desirudin
  • Desipramine
  • Deflazacort
  • Deferiprone
  • Danaparoid
  • Dalteparin
  • Dabigatran Etexilate
  • Cyclosporine
  • Cyclopenthiazide
  • Cortisone
  • Clopidogrel
  • Clopamide
  • Clonixin
  • Clomipramine
  • Citalopram
  • Cilostazol
  • Choline Salicylate
  • Choline Magnesium Trisalicylate
  • Chlorthalidone
  • Chlorothiazide
  • Certoparin
  • Ceritinib
  • Celecoxib
  • Cangrelor
  • Bumetanide
  • Bufexamac
  • Budesonide
  • Bromfenac
  • Bivalirudin
  • Bismuth Subsalicylate
  • Betamethasone
  • Beta Glucan
  • Benzthiazide
  • Bendroflumethiazide
  • Bemiparin
  • Balsalazide
  • Aspirin
  • Argatroban
  • Ardeparin
  • Apixaban
  • Anagrelide
  • Amtolmetin Guacil
  • Amoxapine
  • Amitriptylinoxide
  • Amitriptyline
  • Amineptine
  • Amiloride
  • Acenocoumarol
  • Acemetacin
  • Aceclofenac
  • Abciximab

Patients who are taking one or more of the subsequent drugs could experience a heightened chance of some side effects, however, both medications could end up being the most optimal form of treatment. If your physician chooses to prescribe diclofenac and misoprostol with one of the following medications, they will likely adjust the dosage for both medications.

  • Zofenopril
  • Valsartan
  • Trandolapril
  • Timolol
  • Temocapril
  • Telmisartan
  • Spirapril
  • Sotalol
  • Ramipril
  • Quinapril
  • Propranolol
  • Practolol
  • Pindolol
  • Phenylbutazone
  • Perindopril
  • Pentopril
  • Penbutolol
  • Oxprenolol
  • Olmesartan
  • Nebivolol
  • Nadolol
  • Moexipril
  • Metoprolol
  • Metipranolol
  • Losartan
  • Lisinopril
  • Levobunolol
  • Labetalol
  • Irbesartan
  • Imidapril
  • Fosinopril
  • Esmolol
  • Eprosartan
  • Enalaprilat
  • Enalapril
  • Delapril
  • Colestipol
  • Ciprofloxacin
  • Cilazapril
  • Cholestyramine
  • Celiprolol
  • Carvedilol
  • Carteolol
  • Captopril
  • Candesartan
  • Bisoprolol
  • Betaxolol
  • Benazepril
  • Azilsartan Medoxomil
  • Azilsartan
  • Atenolol
  • Alacepril
  • Acebutolol

Other Interactions

Some medications should never be taken near eating or drinking as there is a higher likelihood of interactions taking place. The use of alcohol or tobacco with some medications could potentially make interactions take place. Consult with your physician how this medication interacts with tobacco, alcohol, or food.

Other Medical Issues

Patients with additional medical issues could potentially experience variations in the levels of effectiveness of this medication. Always ensure your physician is aware of additional medical issues you may have (even if they are unrelated), including:

  • Systemic lupus erythematosus 'take caution, can cause conditions to become worse
  • Swelling of the body or retaining fluid (edema)
  • Stroke (or history of)
  • Stomach bleedingĀ ' take caution; patients should not take this medication
  • Liver disease (counting hepatitis)
  • Kidney disease
  • Intestinal ulcers, stomach ulcers, or bleeding (or history of)
  • Intestinal bleeding 'take caution; patients should not take this medication
  • High blood pressure (hypertension)
  • Heart failure (congestive)
  • Heart disease
  • Heart attack (or history of)
  • Coronary artery bypass graft (heart surgery) patients should not take this medication for pain relief immediately prior to or following surgery
  • Blood disorder (porphyria)
  • Bleeding issues
  • Asthma (Aspirin-sensitive)
  • Asthma
  • Aspirin sensitivity (or history of)
  • Anemia

Warnings

When choosing a medication that is right for you, one must take into consideration the potential risks and should then compare those with the possible benefits. Patients should make this choice with their doctor. The following information is important to consider prior to taking diclofenac and misoprostol.

Allergies

Patients must inform their doctors if they have experienced any reactions at all (allergic or unusual) in regards to this medication or others. It is also important for physicians to be aware of additional kinds of allergies, including to animals, preservatives, dyes, or foods. In regards to products that are non-prescription, patients must carefully read the ingredients list on the container.

Specific Demographic Use

Pediatric

Research conducted to date has not been conducted as to how the pediatric population relates to diclofenac and misoprostol. Take caution; effectiveness and safety have not yet been confirmed.

Geriatric

Research conducted to date has not yet confirmed whether there could be issues that are specific to the geriatric population in regards to diclofenac and misoprostol. Although, caution should be taken as elderly patients could very well be more sensitive to diclofenac and misoprostol side effects when compared to adults who are younger. Older adults tend to have more age-related kidney issues, which could warrant additional caution and a reduction in dosage for these patients.

Pregnancy

Women should avoid diclofenac and misoprostol if they are currently pregnant, and if they have future plans to become pregnant. Contact your physician right away and stop taking diclofenac and misoprostol immediately if you suspect you may have become pregnant. If ingested during pregnancy, this medication can cause severe bleeding, baby could be born too soon (premature birth), or loss of pregnancy (miscarriage).

Women who physically have the capabilities to become pregnant should almost always avoid taking diclofenac and misoprostol. Although, in rare cases, you and your physician may conclude that the diclofenac and misoprostol combination is required to treat you. In these instances, you must always take the following precautions:

  • Utilize an alternate type of birth control that is reliable throughout the course of treatment, and through one month (or one period cycle) following treatment
  • Take a pregnancy test no more than prior to beginning diclofenac and misoprostol with negative results
  • Be sure to only start the diclofenac and misoprostol prescription on either the second or the third day of your period

Breastfeeding

No adequate research has been completed on women who are taking diclofenac and misoprostol while breastfeeding. Women who are breastfeeding should weigh the potential risks against the possible benefits prior to ingesting this medicine.

Additional Warnings

Patients must keep all checkup points to ensure that the physician can monitor their progress consistently. Doctors need to be able to observe to see whether or not the medication is working as it should, and they need to determine whether or not you should still be receiving the prescription. Urine and blood tests could be required in certain circumstances to monitor for undesirable side effects.

Women who take this medication while pregnant can give their child severe birth defects. To ensure safety, always have two methods of birth control planned for backup to be sure you will not become pregnant while taking diclofenac and misoprostol, and when treatment is over. The kinds of birth control that are the most effective are IUD, implants, vaginal rings, shots, patches, and pills (birth control hormones). For men, a vasectomy is an effective option. You should implement one of the above types of birth control and should use it in combination with a cervical cap, diaphragm, or condom. In addition, patients will need to take a pregnancy test prior to being prescribed diclofenac and misoprostol. If you suspect there is a chance you are suddenly pregnant while on this medication, do not continue use and consult with your physician immediately.

There is a possibility that diclofenac and misoprostol can increase the possibility of stroke or heart attack. This is especially true for current heart disease patients. Patients who take this medication for an extended duration could also have an increased risk.

Diclofenac and misoprostol can trigger bleeding within your intestines or stomach. These issues could begin suddenly, without notice. Patients who are more likely to go through this are those who have experienced a stomach ulcer, those who drink alcohol or smoke on a regular basis, those who have poor current health states, those who are taking specific medications (blood thinners or steroid medications) or those who are older than 60.

Consult with your physician immediately if you experience signs of liver issues, including yellowing of the whites of the eyes or skin, pain in the upper stomach, appetite loss, vomiting, nausea, stools that are pale, or urine that is dark in color.

This medication can trigger a severe kind of allergic reaction known as anaphylaxis. Anaphylaxis requires urgent medical care as it could be life-threatening. Consult with your physician immediately if you experience swelling of your mouth, face, or hands; difficulty swallowing; difficulty breathing, hoarseness, itching, or a rash. This medication can trigger severe skin reactions throughout treatment. Consult with your physician immediately if you experience one or more of the subsequent signs while on diclofenac and misoprostol: atypical weakness or tiredness, white dots on lips or in mouth, sore throat, sores, ulcers, red skin lesions, muscle or joint pain, itching, fever, diarrhea, cough, chills, loosening of the skin, peeling, blistering.

Contact your physician immediately if you experience vomiting, stiff back or neck, nausea, appetite loss, headache, the general sensation of illness, drowsiness, or confusion. These symptoms could be signs of aseptic meningitis.

Consult with your physician if you experience edema (body swelling of fluid retention) or weight gain that is unexplained when taking the diclofenac and misoprostol combination.

This drug could cause some patients to experience diarrhea, however, it will typically go away within several days at the most as the body becomes more adjusted to the prescription. However, see your doctor if the signs of diarrhea do not diminish within a week or if it is serious.

Patients who drink alcoholic beverages while taking the diclofenac and misoprostol combination are more likely to experience stomach issues. Alcoholic beverages should be avoided while on this prescription, unless your physician directs otherwise.

Undesired side effects could be increased if patients take anti-inflammatory (nonsteroid) drugs (for instance, asprin, acetaminophen, ketorolac, Toradol, or other salicylates) in addition to the diclofenac and misoprostol combination regularly. The duration for how long patients have taken this medication, and the total amount of each medication taken daily will determine the amount of risk. If your physician prescribes you both of these medications regularly, cautiously follow all of his or her instructions. However, never take aspirin, other salicylates, or acetaminophen with diclofenac and misoprostol for a period longer than several days; and never take ketorolac (Toradol) while on this medication, unless otherwise directed by your physician and is carefully monitoring your condition.

Never take medications unless previously approved by your medical care professional. Your doctor must approve all vitamin and herbal supplements you may be taking, in addition to nonprescription and prescription medications.

Storage

This medication must always be kept in a sealed medication container. It should always be stored far from moisture, freezing, direct light, or heat. Be sure the container is near room temperature.

Store this medication far from the reach of children. Never keep medication past the expiration date on the package. Consult with your medical care professional in regards to properly disposing of unused medication.

Summary

Diclofenac and misoprostol combination is an effective drug that treats pain from osteoarthritis and rheumatoid arthritis. This prescription prevents ulcers by protecting the stomach lining and reducing the amount of stomach acid that is produced. It also helps to lower the production of substances that cause pain and inflammation.