Diclofenac (Oral)

Diclofenac is an anti-inflammatory treatment that is used to relieve mild and moderate pain in patients with joint pains or swellings.

Overview

Diclofenac is a treatment used to offer relief from the symptoms of arthritis. These symptoms include inflammation, stiffness, joint pain and swelling. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can be used for mild or moderate pain relief in these patients.

This treatment is not a cure for arthritis and will need to be taken as an ongoing treatment in order that it may continue to have a positive effect on the patient.

This treatment can also be used to relieve other pain resulting from other conditions. It is used in the treatment of acute migraines, but will not have any result in curing migraine. It can also relieve pain that is caused by ankylosing spondylitis, which affects the joints in the spine. Diclofenac can also relieve the pain suffered from menstrual cramping.

This medication is only available with a prescription from your doctor and is available in the following brands:

  • Zorvolex
  • Zipsor
  • Voltaren-XR
  • Voltaren
  • Cataflam
  • Cambia

The medication can be administered in any of the following forms:

  • Tablet, Extended Release
  • Tablet, Enteric Coated
  • Tablet
  • Powder for Solution
  • Capsule, Liquid Filled
  • Capsule

This treatment can expose the patient to serious side effects that will be significantly worsened if too great a dose is taken or the medication is used for too long a period. Patients must follow the dosing guidelines given to them by their doctor closely in order to ensure the best results.

Condition treated

Arthritis, symptoms of

Migraine, symptoms of

Ankylosing spondylitis, symptoms of

Menstrual cramps, symptoms of

Type Of Medicine

Nonsteroidal anti-inflammatory drug (NSAID)

Side Effects

In addition to the desired pain relief and anti-inflammatory effects of using Diclofenac, there are also a range of unwanted side effects that may occur through use. While not all of the side effects listed herein may occur, in some cases they may require that you seek medical attention:

You should contact your doctor immediately if your use of Diclofenac causes any of the following side effects:

  • Belching or burping
  • Black stools with a tarry appearance
  • Bloating, burning, cramping or pain in the stomach or abdomen
  • Bloody stools
  • Clouded urine
  • Constipation
  • Decreased ability of body to concentrate urine
  • Decreased volume of urine output
  • Diarrhea
  • Dizziness
  • Feeling of indigestion
  • Headaches
  • Increased duration of bleeding
  • Itching skin
  • Loss of hunger
  • Nausea
  • Pain felt in the chest beneath the breastbone
  • Paleness of the skin
  • Rash
  • Severe stomach pains
  • Swelling
  • Troubled breathing when exerting oneself
  • Unusual bleeding
  • Unusual bruising
  • Unusual tiredness
  • Unusual weakness
  • Vomiting
  • Vomiting of blood or of a substance with the appearance of coffee grounds
  • Weight loss

The following side effects can also occur that would not normally necessitate that you seek medical attention. These side effects may be mild and not indicative of any other medical conditions developing. If these side effects become bothersome or are ongoing, however, then you can seek advice from your doctor about how to alleviate these side effects:

  • Excess build up of air or gas in either the stomach or intestines
  • Hearing loss
  • Lack or loss of strength
  • Ongoing ringing or buzzing sound or other unexplained noises heard
  • Passing of gas

It is also possible to overdose when taking Diclofenac medication. If you believe that you or anyone else has overdosed on this medication then you should call the emergency services immediately. The following symptoms of overdose can occur and you should seek help immediately that they do:

  • Agitation
  • Blurring of vision
  • Changed consciousness
  • Changed perception of colors, especially blue or yellow
  • Confusion or disorientation
  • Depression
  • Difficulty when breathing
  • Hives
  • Hostility towards others
  • Irregular heartbeat
  • Irregularity of breathing
  • Irritability or quickness to annoyance
  • Loss of consciousness
  • Muscle twitching
  • Nervousness
  • Pain or discomfort felt in the chest, upper stomach or throat
  • Paleness or bluish tint to lips, fingernails or skin
  • Puffy or swollen around the eyes, face, lips or tongue
  • Rapid weight gain
  • Seizures or convulsions
  • Sleepiness
  • Stupor
  • Swelling of the face, ankles or hands
  • Tightness across the chest
  • Trouble with sleeping
  • Troubled breathing
  • Unusual drowsiness
  • Unusual dullness
  • Unusual feeling of sluggishness

Other side effects that have not been listed herein may also occur. If you experience any other side effects then you should seek the advice of your doctor. If you believe your immediate health to be at risk, however, then you should contact the emergency services at once.

Dosage

This medication should be used for the full course through which it has been prescribed. Stopping use of this treatment will lead to the return of symptoms. You should not take this medication more frequently nor in larger doses than you have been prescribed. This medication should not be used over the long-term as such use can cause a worsening of side effects.

This medication will be prescribed along with a medication guidance booklet that will contain instructions for use. You should follow these instructions carefully and ask your doctor if you have any questions after reading.

When this treatment is being used for arthritis that is continuous this treatment must be taken daily as directed by your doctor. Use of this treatment can take a week to begin working, but it can take longer in some cases before positive effects from use are realized. It may take a number of weeks before the treatment is fully effective.

This medication can be taken with or without food except in the case of diclofenac capsules. These must be taken on an empty stomach.

For the use of the oral solution follow these instructions:

  • Open the medication only when you are ready to take it.
  • Mix with 30-60ml of water.
  • Do not use any other liquid or solution for preparation.
  • Mix well and drink straight away.
  • Add a small amount more liquid to the glass and drink to ensure all of the treatment is taken.

When using this treatment, patients should only take the brand of medication as prescribed by their doctor. Different brands work differently and may not have the same effect.

The dose of this medication will differ for each patient depending on a range of factors. As the treatment can be used for a range of conditions there are numerous different dosing schedules. It is essential that you follow the dosing schedule as prescribed by your doctor only. The following information is provided as a dosing guideline only and should not overrule your prescribed dosing instructions:

When using treatment with capsules:

In the treatment of acute pain:

  • Adults—18-35mg taken 3 times daily.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

For osteoarthritis:

  • Adults—35mg taken 3times daily.
  • Children — Use in children and dose administered must be determined in each case by the prescribing doctor.

When using treatment with delayed-release tablets or enteric-coated tablets:

In the treatment of ankylosing spondylitis:

  • Adults—25mg taken 4 times daily. An additional 25mg dose can be taken at bedtime if required.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

In the treatment of osteoarthritis:

  • Adults—50mg taken 2-3 times daily or 75mg taken twice daily.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

In the treatment of rheumatoid arthritis:

  • Adults—50mg taken 3-4 times daily or 75mg taken twice daily.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

When using treatment with immediate-release tablets:

In the treatment of osteoarthritis:

  • Adults—50my taken 2-3 times daily.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

In the treatment of pain or menstrual cramps:

  • Adults—50mg taken 3 times daily. The first dose of the day only may be increased up to 100mg by your doctor.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

In the treatment of rheumatoid arthritis:

  • Adults—50mg taken 3-4 times daily.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

When using treatment with the solution:

In the treatment of migraine headaches:

  • Adults—One packet of 50mg dosing taken as a one time dose when required.
  • Children—Use in children and dose administered must be determined in each case by the prescribing doctor.

If a dose is missed then it should be taken as soon as possible. If, however, you are close to your next dose then you should skip the missed dose and return to your normal schedule of treatment. You should not take double doses of this treatment.

Interactions

Certain medications should not be used in conjunction with Diclofenac. Use of some medications together can cause interactions in the body that are undesirable. In some cases they may cause severe medical consequences when used together. In other cases they may prevent each other from working or may increase the risk of side effects occurring. You should inform your doctor of all medication you are taking before you receive this prescription and should consult your doctor before beginning to use any other prescriptions.

The following medication is not recommended for use with Diclofenac. Your doctor may decide to change a prescription.

  • Ketorolac

The use of the following medications in conjunction with Diclofenac would not normally be recommended. In some cases, however, both treatments may be required and you may be prescribed with both. Your doctor may change doses or frequency of use:

  • 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

The use of the following in conjunction with Diclofenac would not usually be recommended, as there will be an increased risk of the occurrence of certain side effects. Your doctor may still prescribe both but may need to make adjustments to dose or frequency of use:

  • Zofenopril
  • Valsartan
  • Trandolapril
  • Timolol
  • Temocapril
  • Telmisartan
  • Spirapril
  • Sotalol
  • Ramipril
  • Quinapril
  • Propranolol
  • Practolol
  • Pindolol
  • 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

Interactions with other medications that have not been listed herein may also occur. Patients should check with their doctor before using any other medications in conjunction with Diclofenac. This includes medications purchased over the counter, prescribed medications, herbal remedies and vitamin supplements.

Existing medical problems that the patient suffers from can also have an impact on the use of Diclofenac. Patients will need to share their full medical history with the doctor, including any conditions that they have recovered from. This is especially important in the following cases:

These conditions can be worsened by the use of Diclofenac:

  • Anemia
  • Bleeding problems
  • Blood clotting
  • Congestive heart failure
  • Edema
  • History of heart attack
  • Heart disease
  • Hypertension
  • Kidney disease
  • Porphyria
  • History of stomach ulceration
  • History of stomach bleeding
  • History of stroke

Patients with the following conditions should not use Diclofenac for treatment:

  • History of asthma sensitive to aspirin
  • History of sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Severe kidney disease

Diclofenac should not be used in the period immediately after:

  • Heart surgery

Patients with the following condition may experience increased effects from the drug:

  • Liver disease

Other medical conditions not listed herein may also affect the use of this treatment. You should inform your doctor of all conditions including any not listed here.

Warnings

Before the beginning use of treatment with Diclofenac, it is important that you consider the risks of use in relation to the benefits of using this treatment. The risks of use must be weighed against the good with your doctor and you should ensure that you have taken all of the following into account:

Allergies – If you have had an allergic reaction to any nonsteroidal anti-inflammatory drugs (NSAIDs) in the past then you should not use this treatment. This is also true if you have a history of aspirin sensitive asthma. Inform your doctor of all allergies that you suffer from before use.

Pediatric – The safety and efficiency of use have not been determined in children. You should discuss use with your doctor and more appropriate medications may be found.

Geriatric – No age-specific limitations have been identified from the use of this treatment. Elderly patients are more likely, however, to be suffering from other medical conditions that may limit use and to be taking other medications that may limit use.

Pregnancy – You should inform your doctor that you are pregnant before use of this treatment. There is a demonstrable risk from the use of this treatment during pregnancy that is most pronounced in the 3rd trimester of pregnancy. If there is a chance that you may get pregnant during use then you should inform your doctor of this. Alternative medications may need to be found for use in pregnant women.

Breastfeeding – There are no adequate studies to determine risk. You should weigh the benefits and the risks with your doctor. Your doctor is likely to advise that you do not breastfeed during use of this treatment.

Your doctor will need to carry out regular check ups on you when you are using this treatment. This will enable them to assess effective use and decide if continued use is recommended. Blood and urine tests may also be required to check for unwanted side effects.

Patients taking this medication will be exposed to a greater risk of heart attack or stroke occurring. This will be more likely to occur in patients with heart disease and risks will increase when use of the treatment continues for a prolonged period.

Diclofenac can cause bleeding in the stomach and intestine that occurs suddenly. This is more likely if you are aged 60+, if you are a smoker or are in general poor health.

Patients taking Diclofenac may suffer serious skin conditions. If the skin begins to blister, peel or loosen then you should contact your doctor immediately. Be alert for the presence of any lesions or ulcerations.

Patients should be alert to the side effects of this treatment as these can act as early warning signs of serious medical conditions that can be prevented from worsening if caught early enough. The patient should familiarize themselves with the list of side effects and follow the advice on steps to take if they occur.

Patients taking Diclofenac may experience anaphylaxis, which is a serious allergic reaction to the treatment. This is a life-threatening condition and patients need to be properly prepared to react appropriately should it occur. Symptoms of anaphylaxis should trigger an immediate call to the emergency services and include:

  • Irregular breathing
  • Difficulty breathing
  • Fainting
  • Irregular heartbeat
  • Changes to skin color
  • Swellings
  • Hives
  • Puffiness

Meningitis may occur when using Diclofenac. You should contact your doctor if you experience the symptoms of meningitis which include:

  • Stiffening of the neck
  • Headache
  • Loss of appetite
  • Vomiting
  • Stiffening of the back

You should check with your doctor if you experience any changes to your vision during use of this treatment. You may need to visit a doctor or ophthalmologist if changes occur.

You should inform any other medical professional that you are taking Diclofenac before you begin any other treatment or undergo any other tests. It may be necessary to stop the use of Diclofenac before certain procedures are carried out.

Do not take any other medications in conjunction with Diclofenac without first checking this with your doctor.

Storage

Medication should be stored well out of the reach of children at room temperature. Keep out of direct light, away from moisture and away from heat. Prevent medication from freezing.

Do not keep outdated medication for any longer than is necessary. Dispose of all medication safely and appropriately ensuring that it is out of reach of children at all times.

Summary

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can be used in the treatment of a range of medical conditions.

Typically it is prescribed in the treatment of the symptoms of arthritis to reduce pain, inflammation and soreness of the joints.

Diclofenac is also used in the treatment of migraine pains, menstrual cramps and arthritis of the spine.

Diclofenac is not a cure for any medical condition; instead, it works to relieve the symptoms caused by conditions to allow the patient to operate more normally in life.

Use of this medication will expose the patient to significant risks, including an increased likelihood of suffering from heart attack and stroke. To limit these risks it is essential that the patient follows the dosing schedule as set out by their doctor closely and correctly. Taking too great a dose or using this medication for too great a period of time will put the patient at significant risk.

This medication is not recommended for use in pregnant women. If you are pregnant you should inform your doctor before beginning use. Risk is particularly great in the third trimester of pregnancy.

Before use patients should familiarize themselves with the potential side effects from the use of this medication and determine how to react to each of the side effects. Some side effects can be signs of serious medical conditions that are developing in the patient and will need to be treated urgently to prevent further problems from developing.