Diclofenac
Generic Name: diclofenac (dye KLOE fen ak)
Brand Names: Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, Voltaren, Dyloject
What is 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. 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.
Important information
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 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).
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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.
Before taking this medicine
Diclofenac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.
Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
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 diclofenac is safe for you, tell your doctor if you have:
heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
a history of heart attack, stroke, or blood clot;
a history of stomach ulcers or bleeding;
asthma;
liver or kidney disease;
fluid retention.
Taking diclofenac during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.
Diclofenac is not approved for use by anyone younger than 18 years old.
How should I take diclofenac?
Different brands of diclofenac contain different amounts of this medicine, 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.
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition.
Take Zorvolex on an empty stomach, at least 1 hour before or 2 hours after a meal.
Do not crush, chew, or break an extended-release tablet or delayed-release tablet. Swallow it whole.
Dissolve Cambia powder in 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. Do not take a second dose of diclofenac powder without your doctor's advice. Overuse of migraine headache medicine can make headaches worse. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks.
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.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
See also: Dosage Information (in more detail)
What happens if I miss a dose?
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.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking diclofenac?
Avoid drinking alcohol. It may increase your risk of stomach bleeding.
Avoid taking aspirin or other NSAIDs while you are taking this medicine.
Ask a doctor or pharmacist before using any cold, allergy, or pain medication. Many medicines available over the counter contain aspirin or other medicines similar to diclofenac. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.
Diclofenac side effects
Get emergency medical help if you have signs of an allergic reaction to diclofenac: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat.
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 diclofenac and call your doctor at once if you have:
the first sign of any skin rash, no matter how mild;
shortness of breath (even with mild exertion);
swelling or rapid weight gain;
signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
liver problems - nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
kidney problems - little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;
high blood pressure - severe headache, pounding in your neck or ears, nosebleed, anxiety, confusion;
low red blood cells (anemia) - pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or
severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common diclofenac side effects may include:
indigestion, gas, stomach pain, nausea, vomiting;
diarrhea, constipation;
headache, dizziness, drowsiness;
stuffy nose;
itching, increased sweating;
increased blood pressure; or
swelling or pain in your arms or legs.
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 FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Diclofenac dosing information
Usual Adult Dose for Osteoarthritis:
Diclofenac free acid capsules: 35 mg orally 3 times a day
Diclofenac potassium immediate-release tablets: 50 mg orally 2 or 3 times a day
Diclofenac sodium enteric-coated tablets: 50 mg orally 2 or 3 times a day or 75 mg orally 2 times a day
Maximum dose: 150 mg daily
Diclofenac 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 administered 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; initiate treatment upon appearance of the first symptoms 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 day
Diclofenac sodium enteric-coated and delayed-release tablets: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day
Maximum dose: 225 mg daily
Diclofenac sodium extended-release tablets: 100 mg orally once a day
Maximum dose: 100 mg orally 2 times a day; this would be for the rare patient in whom the benefits outweigh the clinical risks.
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 day
Diclofenac free acid capsules: 18 mg or 35 mg orally 3 times a day
Diclofenac 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.
Comment: Neither the potassium base liquid filled capsules nor the free acid capsules are interchangeable with each other or with other diclofenac products containing the sodium or potassium salt.
Parenteral:
37.5 mg IV bolus over 15 seconds every 6 hours as needed for pain
Maximum Dose: 150 mg per day
Comment: Patients should be well hydrated prior to IV administration of this drug in order to reduce the risk of adverse renal 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).
What other drugs will affect diclofenac?
Ask your doctor before using diclofenac if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.
Tell your doctor about all your current medicines and any you start or stop using, especially:
cyclosporine;
lithium;
methotrexate;
rifampin;
antifungal medicine;
a blood thinner (warfarin, Coumadin, Jantoven);
heart or blood pressure medication, including a diuretic or "water pill";
other forms of diclofenac (Flector, Pennsaid, Solaraze, Voltaren Gel);
other NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), indomethacin, meloxicam, and others; or
steroid medicine (prednisone 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 interactions are listed in this medication guide.
