Diclofenac

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain and inflammation.

Diclofenac is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. Voltaren is also indicated for the treatment of ankylosing spondylitis. The Cataflam brand of this medicine is also used to treat menstrual cramps.

Diclofenac powder (Cambia) is used to treat a migraine headache attack. Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Diclofenac also comes as an injection given into a vein (Dyloject and Zueino). The injection is given by a healthcare provider to treat pain in adults. The injection is approved for use in adults for:

• the management of mild to moderate pain
• the management of moderate to severe pain, alone or in combination with opioid pain medicines.

Diclofenac comes in several oral, injectable, and topical forms. They contain different diclofenac salts and strengths and are not interchangeable, so check the brand and strength each time you fill your prescription.

Take diclofenac exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Use the lowest dose that is effective in treating your condition.

Different brands of diclofenac contain different amounts of diclofenac, and may have different uses. If you switch brands, your dose needs may change. Follow your doctor's instructions about how much medicine to take. Ask your pharmacist if you have any questions about the brand you receive at the pharmacy.

Swallow the tablet whole and do not crush, chew, or break it.

Take Zorvolex on an empty stomach, at least 1 hour before or 2 hours after a meal.

Dissolve the powder form of this medicine (Cambia) with 1 to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Cambia works best if you take it on an empty stomach.

Call your doctor if your headache does not completely go away after taking Cambia.

The diclofenac injection (Dyloject, Zueino) is given into a vein by a healthcare provider. You will not give this injection to yourself.

If you use diclofenac long-term, you may need frequent medical tests.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).

Diclofenac can increase your risk of a fatal heart attack or stroke, especially if you use it long-term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Avoid taking this medicine after a recent heart attack, unless your doctor tells you to.

Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

Diclofenac can increase your risk of a fatal heart attack or stroke, even if you don't have any risk factors. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Avoid taking this medicine after a recent heart attack, unless your doctor tells you to.

Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

You should not use diclofenac if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Do not use Cambia to treat a cluster headache. Do not use Zipsor if you are allergic to beef or beef protein.

To make sure this medicine is safe for you, tell your doctor if you have:

• heart disease, high blood pressure;
• ulcers or bleeding in your stomach;
• asthma;
• liver or kidney disease; or
• if you smoke.

Diclofenac can affect ovulation, and it may be harder to get pregnant while you are using this medicine.

If you are pregnant, you should not take diclofenac unless your doctor tells you to. Taking an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy. You should not take diclofenac after about 30 weeks of pregnancy.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Some brands of diclofenac are not approved for use by anyone younger than 18 years old. Do not give this medicine to a child or teenager without medical advice.

Get emergency medical help if you have signs of an allergic reaction to diclofenac (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Stop using diclofenac and seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath.

Stop using this medicine and call your doctor at once if you have:

• the first sign of any skin rash, no matter how mild;
• flu-like symptoms;
• heart problems - swelling, rapid weight gain, feeling short of breath;
• kidney problems - little or no urinating, painful or difficult urination, swelling in your arms or legs, feeling tired or short of breath;
• liver problems - nausea, diarrhea, stomach pain (upper right side), tiredness, itching, dark urine, jaundice (yellowing of the skin or eyes);
• signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• medication overuse headaches - worsening headaches if you use this medicine too much; or
• low red blood cells (anemia) - pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet.

Common diclofenac side effects may include:

• indigestion, gas, nausea, vomiting, stomach pain;
• diarrhea, constipation;
• headache, dizziness, drowsiness;
• abnormal lab tests;
• itching, sweating;
• stuffy nose;
• increased blood pressure; or
• swelling or pain in your arms or legs.

With the diclofenac injection, pain at the infusion site may also occur.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Usual Adult Dose for Osteoarthritis:

Diclofenac free acid capsules: 35 mg orally 3 times a dayDiclofenac potassium immediate-release tablets: 50 mg orally 2 or 3 times a dayDiclofenac sodium enteric-coated tablets: 50 mg orally 2 or 3 times a day, or 75 mg orally 2 times a dayMaximum dose: 150 mg dailyDiclofenac sodium extended-release tablets: 100 mg orally once a day

Use: For the relief of signs and symptoms of osteoarthritis.

Usual Adult Dose for Ankylosing Spondylitis:

Diclofenac sodium enteric-coated and delayed-release tablets: 25 mg orally 4 times a day. An additional 25 mg dose may be given at bedtime, if necessary.Maximum dose: 125 mg per day

Use: For acute or long-term use in the relief of signs and symptoms of ankylosing spondylitis.

Usual Adult Dose for Dysmenorrhea:

Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day.

Comments: An initial dose of 100 mg orally, followed by 50 mg oral doses, may provide better relief for some patients. Start treatment when the first symptoms appear and continue for a few days.

Use: For the relief of signs and symptoms of primary dysmenorrhea.

Usual Adult Dose for Rheumatoid Arthritis:

Diclofenac potassium immediate-release tablets: 50 mg orally 3 or 4 times a dayDiclofenac sodium enteric-coated and delayed-release tablets: 50 mg orally 3 to 4 times a day, or 75 mg orally twice a dayMaximum dose: 225 mg dailyDiclofenac sodium extended-release tablets: 100 mg orally once a day; maximum 100 mg orally 2 times a day, which would be for the rare patient in whom the benefits outweigh the clinical risks.

Use: For the relief of signs and symptoms of rheumatoid arthritis.

Usual Adult Dose for Migraine:

Diclofenac potassium for oral solution packets: 50 mg (1 packet) orally once.

Comments: This drug is not indicated for the prophylactic therapy of migraine or for use in cluster headaches. The safety and efficacy of a second dose has not been established.

Use: For acute treatment of migraine with or without aura.

Usual Adult Dose for Pain:

Oral:Diclofenac potassium liquid-filled capsules: 25 mg orally 4 times a dayDiclofenac free acid capsules: 18 mg or 35 mg orally 3 times a dayDiclofenac potassium immediate-release tablets: 50 mg orally 3 times a day; an initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief in some patients.

Parenteral (diclofenac sodium injection, such as Dyloject and Zueino):37.5 mg by intravenous bolus over 15 seconds every 6 hours as needed for pain.Maximum dose: 150 mg per day.

Comments: Patients should be well hydrated before intravenous administration of this drug to reduce the risk of adverse kidney reactions.

Uses: For the management of mild to moderate acute pain (oral, IV) and moderate to severe pain alone or in combination with opioid analgesics (IV).

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin or other NSAIDs unless your doctor tells you to.

Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to diclofenac (such as aspirin, ibuprofen, ketoprofen, or naproxen).

Ask your doctor before using diclofenac if you take an antidepressant. Taking certain antidepressants with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all your other medicines, especially:

• heart or blood pressure medication, including an ACE inhibitor, an angiotensin receptor blocker (ARB), a beta-blocker, or a diuretic or "water pill";
• digoxin;
• other forms of diclofenac (Arthrotec, Flector, Pennsaid, Solaraze, Voltaren Gel);
• a blood thinner - warfarin, Coumadin, Jantoven; or
• other NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with diclofenac, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.