Case Evaluation

Diclofenac: Diclofenac Overview

What is Diclofenac?

Diclofenac is the generic name for a prescription medicine to relieve pain, tenderness, swelling, and stiffness associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis (arthritis that mainly affects the spine). Diclofenac immediate-release (short-acting) tablets are also used to treat painful menstrual periods and other types of pain.

Part of a class of medications called "non steroidal anti-inflammatory medications" (NSAIDs), diclofenac works by stopping the body's production of a substance that causes pain, fever, and inflammation.

Diclofenac is manufactured and marketed by Novartis Pharmaceuticals under the names Cataflam and Voltaren-XR. Diclofenac is also manufactured and marketed by Pfizer Pharmaceuticals under the name Arthrotec.

Diclofenac Health Risk: Heart Attack or Stroke

People who take NSAIDs (other than aspirin) such as diclofenac may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning, and may cause death. This risk may be higher for people who take NSAIDs for a long time.

Get emergency medical help right away if you experience chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech. If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), then you should not take diclofenac right before or right after the surgery.

Diclofenac Health Risk: Ulcers

NSAIDs such as diclofenac may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, those older in age, people who are in poor health, or those who drink large amounts of alcohol while taking diclofenac.

If you experience any of the following symptoms, stop taking diclofenac and call your healthcare professional: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.

Diclofenac Precautions

Keep all appointments with your healthcare professional and the laboratory. Your healthcare professional will monitor your symptoms carefully and will probably order certain tests to check your body's response to diclofenac.

Be sure to tell your healthcare professional how you are feeling so that he or she can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.

Your healthcare professional or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with diclofenac, and each time you refill your prescription. Read this information carefully, and ask your healthcare professional or pharmacist any questions you may have.

What Should I Tell My Healthcare Professional?

You should tell your healthcare professional if:

  • you are allergic to diclofenac, aspirin, or other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), any other medications, or any of the inactive ingredients in diclofenac tablets or extended release tablets
  • you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes
  • you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders
  • you have asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose)
  • you have lupus (a condition in which the body attacks many of its own tissues and organs, often including the skin, joints, blood, and kidneys)
  • you have porphyria (an abnormal increase in the amount of certain natural substances made by the liver)
  • you have liver or kidney disease
  • you experience swelling of the hands, feet, ankles, or lower legs
  • you are pregnant (especially the last few months of pregnancy), become pregnant while taking diclofenac, plan to become pregnant, or are breast-feeding
  • you are taking diclofenac before having surgery (including dental surgery)

Diclofenac Side Effects

Tell your healthcare professional if any of the following side effects associated with diclofenac use are severe or persistent:

  • diarrhea
  • constipation
  • gas or bloating
  • headache
  • dizziness
  • ringing in the ears

Call your healthcare professional immediately if you experience any of the following side effects:

  • unexplained weight gain
  • excessive tiredness
  • lack of energy
  • upset stomach
  • loss of appetite
  • itching pain in the upper right part of the stomach
  • yellowing of the skin or eyes
  • flu-like symptoms
  • fever
  • blisters
  • rash
  • hives
  • swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs
  • difficulty breathing or swallowing
  • hoarseness
  • pale skin
  • fast heartbeat
  • cloudy, discolored, or bloody urine
  • back pain
  • difficult or painful urination

Are There Any Interactions With Drugs or Foods?

Diclofenac and certain other medicines can interact with each other. Tell your healthcare professional about all the medicines you take -- including prescription and non-prescription medicines, vitamins, and herbal supplements -- especially:

  • anticoagulants ('blood thinners') such as warfarin (Coumadin)
  • aspirin
  • other NSAIDS such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) or oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone)
  • angiotensin-converting enzyme (ACE) inhibitors such as:
    • benazepril (Lotensin)
    • captopril (Capoten)
    • enalapril (Vasotec)
    • fosinopril (Monopril)
    • lisinopril (Prinivil, Zestril)
    • moexipril (Univasc)
    • perindopril (Aceon)
    • quinapril (Accupril)
    • ramipril (Altace)
    • trandolapril (Mavik)
  • cyclosporine (Neoral, Sandimmune)
  • digoxin (Lanoxin)
  • diuretics ('water pills')
  • insulin and oral medication for diabetes
  • lithium (Eskalith, Lithobid)
  • methotrexate (Rheumatrex).

Unless your healthcare professional tells you otherwise, you may continue your normal diet.

Getting Legal Help

While all medications have certain anticipated side effects, a drug manufacturer has a duty to make its products as reasonably safe as possible, and to inform the medical community and the public of known risks associated with its drugs. If a manufacturer fails to do so, it can be held legally responsible if patients are injured as the result of inadequate warnings or the unreasonably dangerous nature of the drug, under a legal theory called "product liability."

If you or a loved one have experienced any dangerous symptoms or unusual medical conditions while taking diclofenac, you should first contact your doctor or other healthcare professional. You may also wish to meet with an experienced attorney to discuss your options and to protect your right to a legal remedy for any injuries caused by diclofenac use.

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