DICLOFENAC (dye KLOE fen ak) is a non-steroidal anti-inflammatory drug (NSAID). It is used to reduce swelling and to treat pain. It is used for osteoarthritis and rheumatoid arthritis.
The name is derived from its chemical name: 2-(2,6-dichloranilino) phenylacetic acid. In the United Kingdom, India, Brazil and the United States, it may be supplied as either the sodium or potassium salt, in China most often as the sodium salt, while in some other countries only as the potassium salt. Diclofenac is available as a generic drug in a number of formulations.
A substance in the body called cyclo-oxygenase (COX) is involved in the production of various chemicals in the body, including prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation.
Diclofenac blocks the action of COX, so stopping the production of these prostaglandins. This results in less pain, swelling and inflammation.
Diclofenac is also used sometimes to treat pain caused by gout, painful shoulder and cancer. Talk to your doctor about the possible risks of using this medication for your condition.
Diclofenac is used in the treatment of pain and inflammation that is caused by arthritis (rheumatoid arthritis, gouty arthritis, osteo arthritis etc.), ankylosing spondylitis etc. It can also be used in other medical conditions that are painful and due to inflammation.
To read about Diclofenac Sodium (Voltaren), click here.
Diclofenac is used to treat pain, inflammatory disorders, and dysmenorrhea.
Inflammatory disorder may include musculoskeletal complaints, especially arthritis, rheumatoid arthritis, polymyositis, dermatomyositis, osteoarthritis, dental pain, TMJ, spondylarthritis, ankylosing spondylitis, gout attacks, and pain management in cases of kidney stones and gallstones. An additional indication is the treatment of acute migraines. Diclofenac is used commonly to treat mild to moderate post-operative or post-traumatic pain, in particular when inflammation is also present, and is effective against menstrual pain and endometriosis.
As long-term use of diclofenac and similar NSAIDs predisposes for peptic ulcer, many patients at risk for this complication are prescribed a combination (Arthrotec) of diclofenac and misoprostol, a synthetic prostaglandin analogue, to protect the gastric mucosa.
An external, gel-based formulation containing 3% of diclofenac is available for the treatment of facial actinic keratosis caused by over-exposure to sunlight. Some countries have also approved the external use of diclofenac 1% gel to treat musculoskeletal conditions.
In many countries, eye-drops are sold to treat acute and chronic non-bacterial inflammations of the anterior part of the eyes (e.g., postoperative states).
Diclofenac is often used to treat chronic pain associated with cancer, in particular if inflammation is also present (Step I of the World Health Organization (WHO) Scheme for treatment of chronic pain). Good results (sometimes better than those with opioids) have been seen in female breast cancer and in the pain associated with bony metastases. Diclofenac can be combined with opioids if needed. Combaren, a fixed combination of diclofenac and codeine (50 mg each), is available for cancer treatment in Europe. Combinations with psychoactive drugs such as chlorprothixene and/or amitriptyline have also been investigated and found useful in a number of cancer patients.
Fever due to malignant lymphogranulomatosis (Hodgkin's lymphoma) often responds to diclofenac. Treatment can be terminated as soon as the usual treatment with radiation and/or chemotherapy causes remission of fever.
Diclofenac has been found to be effective against all strains of multi drug resistant E. coli, with a MIC of 25 micrograms/ml. Therefore, it may be suggested that diclofenac has the capacity to treat uncomplicated urinary tract infections (UTI) caused by E. coli. It has also been shown to be effective in treating Salmonella infections in mice and is under investigation for the treatment of tuberculosis.
Diclofenac is an antiuricosuric.
Some brands treat different symptoms:
Acute and long-term use in the relief of signs and symptoms of ankylosing spondylitis (delayed-release tablets); acute treatment of migraine attacks with or without aura in adults (oral solution); relief of mild to moderate pain (immediate-release capsules and tablets); relief of signs and symptoms of osteoarthritis and rheumatoid arthritis (immediate-release, ER, and delayed-release tablets); treatment of primary dysmenorrhea (immediate-release tablets).
Treatment of postoperative inflammation after cataract removal; temporary relief of pain and photophobia following corneal refractive surgery.
Treatment of acute pain because of minor strains, sprains, and contusions.
For the treatment of signs and symptoms of osteoarthritis of the knee(s) only.
Treatment of actinic keratosis.
Treatment of pain of osteoarthritis or joint pain amenable to topical treatment (eg, knees, hands).
Treatment of juvenile idiopathic arthritis; treatment of postherpetic neuralgia.
As with any medicine, side effects are possible with diclofenac. However, not everyone who takes the medication will have problems. In fact, most people tolerate it quite well. If side effects do occur, in most cases, they are minor and either require no treatment or can easily be treated by you or your healthcare provider.
Diclofenac is a nonsteroidal anti-inflammatory medication (NSAID). As such, it can cause certain serious side effects that you should report to your healthcare provider. These include, but are not limited to:
Stroke symptoms, such as:
Slurred speech
Weakness on one side of the face or body
Confusion
Heart attack symptoms, such as:
Chest pain
Shortness of breath or other breathing difficulties
Pain in the shoulder, arm, or jaw
Worsening of asthma
High blood pressure (hypertension)
Signs of bleeding of the digestive tract such as dark, tarry stools or bloody vomit
Signs of liver problems, such as yellow eyes or skin (jaundice) or elevated liver enzymes (found using a blood test)
Rapid weight gain, water retention, or unusual swelling of the arms, legs, hands, or feet
Signs of an allergic reaction, including:
An unexplained rash
Hives
Itching
Unexplained swelling of the mouth or throat
Wheezing or difficulty breathing or swallowing.
You must not use diclofenac during pregnancy or if you are trying to become pregnant due to possible harm to the unborn baby and interference with normal labor/delivery. It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby. Tell your doctor before using diclofenac if you are breast-feeding.
Diclofenac has been studied thoroughly in clinical trials. In these studies, the side effects that occurred in a group of people taking diclofenac were documented and compared to side effects that occurred in another group of people using a placebo (a “sugar pill” with no active ingredients). This way, it is possible to see what diclofenac side effects occurred, how often they appeared, and how they compared to the placebo.
As would be expected, the side effects that were reported most commonly with diclofenac varied depending on the type of diclofenac product (oral forms, skin gel, skin patch, or eye drop).
In general, common side effects of the oral forms of diclofenac included:
Abdominal pain (or stomach pain)
Constipation
Diarrhea
Heartburn or indigestion (dyspepsia)
Gas
Nausea
Vomiting
Dizziness
Swelling
Ringing in the ears (tinnitus).
For the forms of diclofenac that are applied to the skin (gels, patches, and topical solution), skin irritation is the most common side effect. As would be expected, the most common side effects of the eye drop form of diclofenac were related to the eyes (eye inflammation, burning and stinging, and tear problems).
Diclofenac may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use diclofenac just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.
Diclofenac may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking diclofenac, especially in older adults.
Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.
Ask a doctor or pharmacist before using any cold, allergy, or other pain medicine. Medicines similar to diclofenac are contained in many combination medicines. 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. Avoid drinking alcohol. It may increase your risk of stomach bleeding.
Do not use diclofenac just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Diclofenac may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.
This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking diclofenac, especially in older adults.
You should not use this medication if you are allergic to diclofenac, or if you have a history of allergic reaction to aspirin or other NSAIDs.
To make sure you can safely take diclofenac, tell your doctor if you have any of these other conditions:
a history of heart attack, stroke, or blood clot;
heart disease, congestive heart failure, high blood pressure;
a history of stomach ulcers or bleeding;
liver or kidney disease,
asthma;
polyps in your nose;
a bleeding or blood clotting disorder; or
if you smoke.
You must not use diclofenac during pregnancy or if you are trying to become pregnant due to possible harm to the unborn baby and interference with normal labor/delivery. It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby. Tell your doctor before using diclofenac if you are breast-feeding. Do not give this medicine to a child younger than 18 years old without medical advice.
ACE inhibitors
Antihypertensive effect of ACE inhibitors may be diminished. In addition, the risk of nephrotoxicity associated with ACE inhibitors or diclofenac may be increased. Closely monitor BP. If BP control decreases, it may be necessary to discontinue diclofenac. Periodic measurement of renal function may be necessary.
Alcohol
The risk of GI bleeding may be increased. Use with caution.
Aminoglycosides (eg, gentamicin)
Aminoglycoside concentrations may be elevated, increasing the risk of adverse reactions (eg, acute renal insufficiency). If coadministration cannot be avoided, reduce the aminoglycoside dose before starting diclofenac. Monitor renal function and aminoglycoside serum concentrations and adjust the dose as needed.
Antiplatelet agents (eg, clopidogrel)
The risk of bleeding may be increased. Use with caution. Closely monitor for signs of bleeding.
Aspirin
Protein binding of diclofenac may be reduced; in addition, the risk of gastric erosion and bleeding may be increased. The clinical importance of this interaction is not known; however, as with other NSAIDs, coadministration is not generally recommended because of the potential of increased adverse effects.
Azole antifungal agents (eg, fluconazole)
Diclofenac plasma concentrations may be elevated, increasing the risk of adverse reactions. Observe the clinical response of the patient and adjust the diclofenac dose as needed.
Corticosteroids (eg, prednisone)
The risk of GI bleeding may be increased. Use with caution. Advise patients about the signs and symptoms of GI bleeding.
Cyclosporine
The nephrotoxicity of both agents may be increased. Use with caution and closely monitor for nephrotoxicity.
Food Diclofenac potassium
The extent of diclofenac potassium absorption is not affected when diclofenac potassium is taken with food; however, the rate of absorption is reduced by food, as indicated by a delay in onset and a decrease in C max.
Diclofenac sodium
Food has no effect on the extent of diclofenac absorption; however, there usually is a 1- to 4.5-hour delay in the onset of absorption and a reduction in C max of less than 20%.
Oral solution
High-fat food had no effect on the extent of diclofenac potassium absorption; however, there was a reduction in C max of approximately 70% after a high-fat meal. Decreased C max may be associated with decreased effectiveness. Taking diclofenac potassium oral solution with food may cause a reduction in effectiveness compared with taking it on an empty stomach.
Furosemide, thiazide diuretics
May inhibit diuretic and antihypertensive effects. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with NSAIDs, closely observe the patient for signs of renal failure, as well as to ensure diuretic efficacy.
Heparin
Risk of hemorrhagic adverse reactions may be increased. Closely monitor coagulation status and adjust the heparin dosage accordingly.
Hepatotoxic agents (eg, acetaminophen, certain antibiotics [eg, aminoglycosides (eg, gentamicin)], antiepileptic agents)
The risk of hepatotoxicity may be increased. Use with caution. Closely monitor for signs and symptoms of hepatotoxicity.
Hibiscus sabdariffa
Diclofenac urinary excretion may be reduced, increasing diclofenac concentrations and risk of adverse reactions. Patients taking diclofenac should avoid beverages made from Hibiscus sabdariffa flowers.
Lithium
May decrease lithium Cl, increasing lithium concentrations and risk of toxicity. These effects have been attributed to inhibition of renal prostaglandin synthesis by the NSAID. Closely monitor for signs of lithium toxicity.
Methotrexate
May increase methotrexate levels. Use with caution.
Quinolones (eg, levofloxacin)
Risk of CNS stimulation and seizures from quinolones may be increased. In addition, quinolone plasma concentrations may be increased. Use with caution.
Serotonin norepinephrine reuptake inhibitors (eg, venlafaxine), SSRIs (eg, fluoxetine)
Risk of upper GI bleeding may be increased. Use with caution. Closely monitor for signs of GI bleeding. Advise patients about the signs and symptoms of GI bleeding.
Smoking (one should never smoke)
The risk of GI bleeding may be increased. Use with caution.
Tenofovir
Pharmacologic and toxic effects (eg, nephrotoxicity) of tenofovir may be increased. Use with caution. Consider use of an analgesic other than an NSAID.
Triamterene
Coadministration of diclofenac and triamterene may cause a sudden onset of nephrotoxicity. If renal function deteriorates during coadministration of these agents, consider stopping one or both drugs.
Warfarin
May increase risk of gastric erosion and bleeding. Closely monitor coagulation status and adjust the warfarin dosage accordingly. Monitor for signs of GI bleeding. Advise patients about the signs and symptoms of GI bleeding.
Review by berns13: User Rating: 9.0
diclofenac for Pain: I only use the drug 3 or 4 days when stiffness arises. I find it helps and relieves muscle aches.
Review by Sajonna: User Rating: 8.0
diclofenac for Osteoarthritis: I just tried this about 2 weeks ago for my arthritis pain. I am taking the generic version of this, one a day, 75 mg. So far it is working. I would like to see how it works this coming winter when I have the most amount of pain. So far, so good though.
Review by kcp: User Rating: 10
diclofenac for Osteoarthritis: I have osteoarthritis as well as residual pain from a serious back surgery 4 years ago. I have been taking Naproxen for four years and just could not control the pain without occasional doses of a narcotic. I cannot believe how much better I feel. I have been back out on my bike and working in the garden. Things I have not been able to do all summer. So far, I am very impressed. We will see what happens this winter.
Review by Anonymous: User Rating: 9.0
diclofenac for Rheumatoid Arthritis: i use it for arthritis pain they thing i have fibromyalgia, it has worked great!! also has helped the pain in my heel where i have a spur...nothing else helped that...its wonderful!!
Review by AlfaRomeoj10: User Rating: 10
diclofenac for Pain: I have a damaged lower back from a car accident and back often spasms. I only need to take diclofenac for a couple of days and I'm back fighting fit again. It also helps with my sleep and nausea.
Review by Anonymous: User Rating: 8.0
diclofenac for Pain: I take diclofenac for chronic back pain. I take one diclofenac every 12 hours and it is very effective. I had mild dizziness and upset stomach early in treatment but now have no side effects at all. When my back gets bad, I still take muscle relaxers, narcotic pain relievers, and chiropractic treatment (when I can afford it), but diclofenac helps me manage things so as to reduce the need for stronger medicines.
Review by Anonymous: User Rating: 9.0
diclofenac for Osteoarthritis: 6 days into using this medicine and the pain has gone. As yet no side effects.
Review by DrB1: User Rating: 9.0
diclofenac for Rheumatoid Arthritis: Pain and inflammation cleared up within 2 days. Took a couple hours to take effect. I had to take it for a week at breakfast and lunch, now just using as needed. I have not noticed any side effects. With some of the medications I was given, I had severe muscle cramping, etc. Stronger pain medicine had almost no effect. Previously had much difficulting moving and sleeping. Diclofenac solved this for me. So far this is a great medicine.
Review by Anonymous: User Rating: 10
diclofenac for Osteoarthritis: The only medication that helps since Vioxx was removed from the market.
Review by Anonymous: User Rating: 6.0
diclofenac for Frozen Shoulder: The first day I took this medicine I was disturbed because suddenly I noticed the itching and indigestion followed after dinner. Could not get a wink of sleep because I kept getting up because of acid reflux that kept me trying to clear my voice. Beware and see your Doctor immediately.
Review by Frankenbutt: User Rating: 8.0
diclofenac for Osteoarthritis: I was prescribed this along with tramadol (Ultram) to deal with pain associated with hip and knee arthritis prior to my hip resurfacing procedure. The combination worked work very well for me although I still needed a cane. I also got some cortisone injections in my knees which were [very] helpful. Since the surgery 1 month ago, I've been able to discontinue the tramadol and now only take the diclofenac occasionally (1 a day, 2-3 x a week). However, it does make me a bit lethargic, and I notice that my legs do swell and I seem to urinate less volume (sorry for the details). I do recommend the diclofenac, however.
Review by Anonymous: User Rating: 10
diclofenac for Back Pain: I'm currently taking it for sciatic nerve pain. Have previously taken narcotics with very little effect. Diclofenac works ... Mild upset stomach so far but not bad at all. I've also noticed that the drug seems to become more active when taken with a decent amount of food and when you are active.
Review by Anonymous: User Rating: 8.0
diclofenac for Osteoarthritis: Great for pain but the nausea and stomach pain are terrible.
Review by Anonymous: User Rating: 9.0
diclofenac for Back Pain: I'm a 61 year old male. I have a herniated disc in my lower back. I was in severe pain. I received a series of steroid injections that really helped. Gradually the pain returned but not near as severe as the initial pain but bad enough to cause me a lot of discomfort. I've since been taking one diclofenac 75 mg tablet with one tramadol 50 mg tablet every morning. This combination works just great for me and gets me through my work day. The diclofenac and the tramadol seem to enhance each other's effect I think. The only side effect that I've noticed from this is slight constipation and a slight loss in appetite.
Review by Anonymous: User Rating: 9.0
diclofenac for Back Pain: I've tried a lot of things to help with my back pain. The latest going to chiropractor for 2 months. Things just did not get better. I called my doctor to go with some pain medicines and looked into seeing an orthopedic doctor for steroid shot. They prescribed this and I have been taking it now for 5 days and my back pain is gone. It felt much better on day 1 and each day was better and better. I take one tablet every 12 hours.
Review by akasuga: User Rating: 1.0
diclofenac for Rheumatoid Arthritis: I was prescribed diclofenac for rheumatoid arthritis. 75mg/2 times per day. I didn't find it helped me at all. Now switched to ... 200mg/day and feeling much better.
Review by silverfox1944: User Rating: 1.0
diclofenac for Sciatica: My sister had terrible side effects with this medicine. Rapid heartbeat, sweating, tingling arms and legs, itching, burning of her skin. She changed all laundry products and body soaps looking for relief.
Review by Anonymous: User Rating: 9.0
diclofenac for Sciatica: My GP tried me on several combinations of drugs combined with Ibuprofen over a 6 week period for Sciatica. Not until the Ibuprofen was substituted with Diclofenac did I get any signs of improvement. Taken with Omeprazole I have had no side effects.
Review by RA Relief: User Rating: 10
diclofenac for Rheumatoid Arthritis: I have been on diclofenac 75mg twice a day for 5 years. The first year I took it 2 X each day. After the methotrexate began to kick in, I now only take it when needed when I get a flare up. At the most, only about once per week, sometimes less. It has made a big difference in helping me manage the pain of rheumatoid arthritis.
Review by Anonymous: User Rating: 8.0
diclofenac for Muscle Pain: It works very well.