Medicines

Diclofenac

Sounds like 'dye-KLOE-fen-ak'

Overview
Clinicians

Easy-to-read medicine information about diclofenac – what it is, how to take diclofenac safely and possible side effects.

Type of medicine	Also called
Analgesic (pain killer) Anti-inflammatory Belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs)	Voltaren® Diclofenac (Dr Reddy's)®

What is diclofenac?

Diclofenac is one of a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).
It is used to treat different types of pain such as muscle pain, dental pain, migraine and pain resulting from injury or after surgery.
Diclofenac also helps to ease redness and swelling caused by injury.
It blocks the inflammation process in your body and in this way eases swelling and pain.

Dose

The usual dose of diclofenac is 25 or 50 milligrams every 8 hours.
Always take your diclofenac exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much diclofenac to take, how often to take it, and any special instructions.

How to take diclofenac

Take diclofenac with food or immediately after food, to prevent stomach upset.
Swallow the tablets with a full glass of water. Do not crush or chew them.
Usually, you may only need to take diclofenac for a short period of time, while you have pain or swelling.
Limit or avoid alcohol while you are taking diclofenac. Alcohol can increase the risk of stomach side effects.
It is not harmful if you miss your diclofenac dose. If you miss a dose, take it when you remember, with or after food. Do not take double the amount of tablets.

Take care

For most people, taking diclofenac is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, your kidney do not work very well or you smoke.
Discuss with your doctor if taking diclofenac is suitable for you.
Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac increase the chance of a heart attack or stroke, either of which can lead to death. These serious side effects can occur as early as the first weeks of using an NSAID and the risk may increase the longer you are taking an NSAID.
The risk appears greater at higher doses; use the lowest effective amount for the shortest possible time.
Seek medical attention immediately if you experience symptoms such as:
- chest pain
- shortness of breath or trouble breathing
- sudden weakness or numbness in one part or side of the body
- sudden slurred speech.
Many medicines contain NSAIDs, including those used for colds, flu, so it is important to read the labels and avoid taking multiple medicines that contain NSAIDs.

Possible side effects

Like all medicines, diclofenac can cause unwanted side effects, although not everyone gets them.

Side effects	What should I do?
Heartburn Indigestion Stomach discomfort	Take diclofenac with food.
Serious stomach problems such as really bad stomach pain, blood in the stool or black stools, cough or vomit up blood or dark coloured vomit.	Tell your doctor immediately or ring HealthLine on 0800 611 116
Allergic reaction such as skin rash, itching, swelling of the lips, face, and mouth or difficulty breathing	Tell your doctor immediately or ring HealthLine on 0800 611 116
Chest pain Shortness of breath or trouble breathing Weakness in one part or side of the body Slurred speech	Tell your doctor immediately or ring HealthLine on 0800 611 116

Interactions

Diclofenac interacts with some important medications, so check with your doctor or pharmacist.
Do not take other NSAID medication such as ibuprofen or naproxen while you are taking diclofenac.

Learn more

New Zealand Formulary Patient Information:
Diclofenac

Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr J Bycroft. Health Navigator NZ Last reviewed: 13 Jul 2015 Page last updated: 18 Oct 2016

Information for clinicians

Alerts

FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. FDA Safety Communication, July 2015
- NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, either of which can be fatal. There are a large number of studies that support this finding, with varying estimates of how much the risk is increased. Estimates of increased risk range from 10 percent to 50 percent or more, depending on the drugs and the doses studied. This risk may occur as early as the first weeks of treatment and may increase with duration of use.
- Remain alert for the development of cardiovascular adverse events throughout the patient’s entire treatment course, even in the absence of previous cardiovascular symptoms.
- Inform patients to seek medical attention immediately if they experience symptoms of heart attack or stroke such as chest pain, shortness of breath or trouble breathing, sudden weakness or numbness in one part or side of the body, or sudden slurred speech.
- Based on available data, it is unclear whether the risk for cardiovascular thrombotic events is similar for all non-aspirin NSAIDs.
- The increase in cardiovascular thrombotic risk has been observed most consistently at higher doses.
- The relative increase in serious cardiovascular thrombotic events over baseline conferred by NSAID use appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease. However, patients with known cardiovascular disease or risk factors had a higher absolute incidence of serious cardiovascular thrombotic events due to their increased baseline rate.
- To minimize the risk for an adverse cardiovascular event in patients treated with an NSAID, prescribe the lowest effective dose for the shortest duration possible.
- Some NSAIDs, including those in OTC products such as ibuprofen and naproxen, can interfere with the antiplatelet action of low dose aspirin used for cardioprotection by blocking aspirin’s irreversible COX-1 inhibition.
The Triple Whammy-Safe Prescribing - A Dangerous Trio (SAFE Rx Bulletin)
- ACE inhibitor or angiotensin II receptor antagonist ('sartan')
- Diuretic
- NSAID or Coxib

Medsafe NZ Data sheets

Drug Formulary NZ

Diclofenac Potassium

Medsafe prescriber updates

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors (Dec 2010)
Medicines interaction report - NSAIDs (May 2009)
Non-Selective NSAIDS – Cardiovascular, Skin And Gastrointestinal Risks (June 2008)
NSAIDs can cause lower GIT damage (May 2001)
Necrotising Fasciitis Associated with NSAIDs (Oct 2000)
NSAID-induced Bronchospasm - A Common & Serious Problem (Mar 1999)

BPAC article - NSAIDs - Strategies for minimising harm Dec 2004