Diclofenac

Sounds like 'dye-KLOE-fen-ak'

Overview
Clinicians

Easy-to-read medicine information about diclofenac – what it is, how to take it 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 in 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 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 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 with diclofenac

For most people, taking diclofenac is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers or kidney problems or if 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, which can lead to death. These serious side effects can occur even in the first weeks of using NSAIDs and the risk may increase the longer you are taking them. 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.
Some other medicines contain NSAIDs, including those used for colds, flu, so always read the labels and avoid taking multiple medicines that contain NSAIDs.

Precautions - before taking diclofenac

Do you have high blood pressure or problems with your heart?
Do you have any problems with the way your kidneys or liver works?
Have you had stomach ulcers?
Are you pregnant or breast-feeding?
Do you have any breathing problems?

If so, it’s important that you tell your doctor before you start taking diclofenac. Sometimes a medicine isn’t suitable for a person with certain conditions, or taking other medicines or it can only be used with extra care.

Possible side effects

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

Side effects	What should I do?
Heartburn Indigestion Stomach discomfort	Take diclofenac with food. Talk to your doctor if it is painful.
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

Dicofenac interacts with some medicines, especially those used for high blood pressure, so check with your doctor or pharmacist before you start taking it.
Do not take other NSAIDs such as ibuprofen or naproxen while taking diclofenac. This can increase your risk of side effects.
Taking NSAIDs together with medicines called ACE inhibitors and diuretics (water pills) can be harmful to your kidneys. If you are taking ACE inhibitors and diuretics, tell your doctor or pharmacist before starting ibuprofen.
Examples of ACE inhibitors are captopril, cilazapril, enalapril, lisinopril, perindopril, quinapril and trandolapril.
Examples of diuretics are furosemide, bumetanide, bendroflumethiazide, chlortalidone, indapamide and metolazone.
Read more: The triple whammy SafeRx

Learn more

New Zealand Formulary Patient Information: Diclofenac

References

Diclofenac sodium (systemic) New Zealand Formulary

Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr J Bycroft. Health Navigator NZ Last reviewed: 31 Jul 2017 Page last updated: 11 Dec 2017

Information for clinicians

This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).

Medsafe prescriber updates

NSAIDs and risk of cardiovascular events (September 2013)
Key messages All non-steroidal anti-inflammatory drugs (NSAIDs) are associated with a small increased risk of serious cardiovascular adverse events. The risk is increased with high doses, increasing duration of use and in patients with other cardiovascular risk factors. The lowest effective NSAID dose should be used for the shortest possible duration. The overall benefit to risk of harm balance of NSAIDs remains positive. Patients requiring long-term NSAID therapy should be regularly reviewed for efficacy, adverse effects and the development of cardiovascular risk factors. Effectiveness of different NSAIDs may vary between individual patients. Read more: NSAIDs and Risk of Cardiovascular Events

NSAIDs and risk of cardiovascular events (September 2013)

Key messages

All non-steroidal anti-inflammatory drugs (NSAIDs) are associated with a small increased risk of serious cardiovascular adverse events.
The risk is increased with high doses, increasing duration of use and in patients with other cardiovascular risk factors.
The lowest effective NSAID dose should be used for the shortest possible duration.
The overall benefit to risk of harm balance of NSAIDs remains positive.
Patients requiring long-term NSAID therapy should be regularly reviewed for efficacy, adverse effects and the development of cardiovascular risk factors.
Effectiveness of different NSAIDs may vary between individual patients.
Read more: NSAIDs and Risk of Cardiovascular Events

NSAIDs and acute kidney injury (June 2013)
Key messages All NSAIDs (including COX-2 inhibitors) have been associated with the development of acute kidney injury. Acute kidney injury is more likely to occur in patients with other risk factors — particularly hypovolaemic states. Other risk factors include: Increasing age (>65 years), chronic hypertension and atherosclerosis. Pre-exisiting renal or glomerular disease. Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists. Use of the 'triple whammy' (concurrent use of ACE inhibitor or angiotensin-II receptor antagonist plus diuretic plus NSAID). Renal function should be monitored in at risk patients. If acute kidney injury occurs, the NSAID should be stopped. NSAIDs should be avoided in patients who develop or have a history of interstitial nephritis. Read more: NSAIDs and Acute Kidney Injury

NSAIDs and acute kidney injury (June 2013)

Key messages

All NSAIDs (including COX-2 inhibitors) have been associated with the development of acute kidney injury.
Acute kidney injury is more likely to occur in patients with other risk factors — particularly hypovolaemic states. Other risk factors include:

Increasing age (>65 years), chronic hypertension and atherosclerosis.
Pre-exisiting renal or glomerular disease.
Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists.
Use of the 'triple whammy' (concurrent use of ACE inhibitor or angiotensin-II receptor antagonist plus diuretic plus NSAID).

Renal function should be monitored in at risk patients.
If acute kidney injury occurs, the NSAID should be stopped.
NSAIDs should be avoided in patients who develop or have a history of interstitial nephritis.
Read more: NSAIDs and Acute Kidney Injury

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors (December 2010)
For all patients requiring treatment with either a non-selective NSAID or COX-2 inhibitor, the extent and severity of gastrointestinal events can be reduced by: Using the lowest effective dose for the shortest duration possible. Avoiding the concomitant use of more than one NSAID, or a NSAID with a COX-2 inhibitor. Avoiding the concomitant use of aspirin and/ or an anticoagulant where possible. If such a combination is necessary, a gastro-protective agent such as a proton pump inhibitor should be considered. Informing patients of, and monitoring for, signs and symptoms of gastrointestinal adverse events. Identifying patients with risk factors for serious GI adverse events and considering the use of a gastro-protective agent such as a proton pump inhibitor. Read more: Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors (December 2010)

For all patients requiring treatment with either a non-selective NSAID or COX-2 inhibitor, the extent and severity of gastrointestinal events can be reduced by:

Using the lowest effective dose for the shortest duration possible.
Avoiding the concomitant use of more than one NSAID, or a NSAID with a COX-2 inhibitor.
Avoiding the concomitant use of aspirin and/ or an anticoagulant where possible. If such a combination is necessary, a gastro-protective agent such as a proton pump inhibitor should be considered.
Informing patients of, and monitoring for, signs and symptoms of gastrointestinal adverse events.
Identifying patients with risk factors for serious GI adverse events and considering the use of a gastro-protective agent such as a proton pump inhibitor.
Read more: Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors