What is diclofenac and what is it used for?

What is diclofenac? | How it works | Dosages | Restrictions | Warnings | Side effects | Interactions | Diclofenac alternatives | Diclofenac savings

Diclofenac is a prescription drug that is classified as part of the non-steroidal anti-inflammatory drug (NSAID) class of medications. It can be used to treat mild to moderate pain, symptoms of osteoarthritis or rheumatoid arthritis, ankylosing spondylitis, and other conditions such as menstrual cramps and acute migraine attacks. 

Diclofenac is approved by the United States Food and Drug Administration (FDA) and is available by prescription only, although topical diclofenac is now available both by prescription and over-0the-counter. Common brand names of diclofenac include Voltaren, Voltaren-XR, Cataflam, Flector, Zipsor, Zorvolex, and Cambia. Diclofenac is available in various dosage forms, including tablets, capsules, powder for solution, and topical. 

What is diclofenac, and what is it used for?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Used to treat mild to moderate pain from arthritis and other conditions, it is not a controlled substance or narcotic. It is available in various formulations and in brand and generic forms, as outlined below. Most forms of diclofenac are available by prescription only. However, topical diclofenac is now available over the counter as well as by prescription.

For reference, there are various forms of this medication. Forms of diclofenac that are available by prescription include:

Diclofenac is also available over-the-counter as a topical medication. It is used to treat joint pain. Some examples of these OTC medicines include Voltaren Arthritis Pain, Aspercreme Arthritis Pain, Dr. Scholl’s Arthritis Pain Reliever, and Salonpas Arthritis Pain Relief Gel. 

How does diclofenac work?

As an NSAID, diclofenac can help with pain and inflammation, and even has fever-lowering activity. The way diclofenac works is not completely understood, but it is thought to work by inhibiting enzymes called cyclooxygenase (COX-1 and COX-2) from making prostaglandins. Prostaglandins cause pain, inflammation, and fever. By decreasing the body’s production of prostaglandins, symptoms of pain, inflammation, and fever can improve.

How to take diclofenac

Different formulations of diclofenac may have different uses. When you get your prescription, carefully read the medication label and any patient information leaflets and/or medication guides you receive. Ask your healthcare provider or pharmacist if you have any questions or concerns. Take or use diclofenac exactly as prescribed. Do not take more medication than your doctor prescribes. Your doctor will tell you how many times a day and when to take diclofenac, depending on the formulation. 

• If you are taking diclofenac tablets, swallow the tablet whole. Do not chew, crush, or break the tablet. 
• If you take Zorvolex, take it on an empty stomach. This means either one hour before a meal or two hours after a meal. 
• If you are prescribed Cambia, dissolve the powder in one or two ounces of water. Stir and drink the entire mixture immediately. Take Cambia on an empty stomach. Call your doctor if your headache does not go away after you take Cambia.
• Other than Zorvolex or Cambia, diclofenac can be taken with food to minimize stomach adverse effects.
• Store diclofenac at room temperature, away from direct light, heat, and moisture. Do not store it in the bathroom. Keep out of sight and out of reach of children and pets. Keep the bottle tightly closed when not in use.
• If you miss a dose of diclofenac, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose. Do not take extra doses to try to make up for a missed dose. 

Diclofenac safety information

Restrictions

Consult your healthcare provider before taking diclofenac. Tell your doctor about any medical conditions and medical history. Diclofenac is not safe for everyone. Diclofenac is contraindicated (should not be taken) for certain people, including:

• People who are allergic to diclofenac, any NSAID, or any ingredient in the medication
• People with aspirin-induced asthma or hives
• People with NSAID-induced asthma or hives
• People with aspirin triad (this means they have all three of the following: aspirin or NSAID allergy, asthma, and sinus disease with nasal polyps)
• People who are undergoing heart bypass surgery (CABG)
• People with kidney problems or severe kidney disease
• Pregnant women beginning at 20 to 30 weeks of pregnancy (diclofenac could cause harm to the unborn baby)

Diclofenac may or may not be used in certain other patients, depending on individual circumstances. The healthcare provider will weigh the risks and benefits. If it is used, diclofenac should be used cautiously and the patient should be closely monitored. These individuals include:

• Pregnant women before 20 to 30 weeks of pregnancy
• Older adults
• Debilitated (in a weakened state) patients 
• People with kidney problems, liver problems, or liver disease 
• People with asthma
• People who have had a recent heart attack
• People with cardiovascular disease
• People who are at risk for heart disease due to risk factors or a family history of heart disease
• People with hypertension (high blood pressure)
• People with congestive heart failure (CHF)
• People with fluid retention
• People with blood clotting disorders
• People with a history of gastrointestinal bleeding or stomach ulcers
• People who smoke 
• People who consume alcohol
• People who are dehydrated
• Women who are trying to conceive
• People who take diclofenac for a long period of time (doing so increases the risk of serious complications)

Warnings

Because of potential risks, diclofenac should always be prescribed at the lowest effective dose for the shortest possible time. 

Diclofenac has a black box warning. This is the strongest warning required by the FDA. This warning applies to all NSAIDs and states:

• NSAIDs increase the risk of serious heart and clotting complications. This includes heart attack and stroke, which can cause death. This risk can occur early in treatment, and the risk increases the longer the medication is taken. 
• Diclofenac should never be taken before or after CABG surgery.
• NSAIDs cause a higher risk of severe gastrointestinal problems, including bleeding, ulcers (sores), and perforation (holes) of the stomach or intestines, which can cause death. These complications can occur any time during diclofenac treatment, with or without warning. Older adults and patients with a history of ulcers or GI bleeding are at higher risk for these complications.

 Other warnings include:

• Liver problems: Diclofenac may cause liver problems. Patients should be alert to symptoms of liver problems such as dark urine, clay-colored stools, nausea, fatigue, itching, stomach pain, and yellowing of the skin and whites of the eyes. 
• High blood pressure: Diclofenac can worsen high blood pressure or can cause high blood pressure. High blood pressure can contribute to an increased risk of heart events. Patients taking diclofenac should have their blood pressure monitored regularly. 
• Heart failure and edema: Patients with severe heart failure generally should not take diclofenac. Patients with heart failure who are prescribed diclofenac will be closely monitored.
• Kidney problems: Taking an NSAID for a long time can cause kidney problems. Patients at higher risk include older adults, individuals with kidney, liver, or heart problems, people who are dehydrated, or patients who take a diuretic (water pill), ACE inhibitor, or ARB. In many cases, stopping the NSAID will resolve the problem. People with severe kidney problems should not take diclofenac.
• Hyperkalemia (high potassium levels): Potassium levels may increase while taking an NSAID.
• Anaphylactic reactions: A severe allergic reaction can occur in patients with or without a known allergy. Patients who experience hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, should get emergency medical help. 
• Asthma exacerbation: Patients with aspirin sensitivity, asthma, and sinus conditions with nasal polyps (aspirin triad) should not take diclofenac. 
• Serious skin reactions: In rare cases, life-threatening skin reactions can occur from NSAIDs such as diclofenac. These reactions are known as exfoliative dermatitis, Stevens-Johnson Syndrome, and toxic epidermal necrolysis. These serious events can occur without warning and can be fatal. Patients who take diclofenac should be alert to fever, burning eyes, sore throat, skin pain, red or purple rash, or blistering/peeling skin. These symptoms require emergency medical attention. 
• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): This is a type of drug reaction that can affect many parts of the body. Symptoms may include fever, swollen lymph nodes, and/or facial swelling. If any of these symptoms occur, stop taking diclofenac and get emergency medical attention. 
• Pregnancy: NSAIDs like diclofenac can cause harm to an unborn baby, especially after 20 weeks of pregnancy until birth. Women who are pregnant or planning to become pregnant should always consult their healthcare provider before using any new medication. If you already take diclofenac and find out you are pregnant, consult your healthcare professional for medical advice. 

Side effects

Before taking diclofenac, tell your physician about any medical conditions you have, as well as your family history and medical history. Individuals taking diclofenac may commonly experience stomach problems such as abdominal pain, indigestion, nausea, vomiting, diarrhea or constipation, and/or gas. 

Other common side effects of diclofenac may include: 

• Headache
• Dizziness 
• Skin reactions: rash, itching, hives
• Increased liver function tests
• Drowsiness 
• Swelling of the extremities (legs, ankles, feet, hands, arms)
• Tinnitus (ringing in the ears) 
• Bruising
• Sun sensitivity (patients should avoid tanning beds and the sun when taking diclofenac—and use extra caution when in the sun, wearing protective clothing and applying sunscreen of SPF 30 or higher)
• Delayed ovulation (women who are trying to conceive or having trouble conceiving should consult their healthcare professional before taking diclofenac)

Serious side effects of diclofenac may include:

• Gastrointestinal bleeding, perforation (holes), and ulcers (sores)
• Heart and clotting problems including heart attack, stroke, blood clots, heart failure
• High blood pressure
• Kidney problems or kidney failure
• Liver problems
• Pancreas problems
• Serious and life-threatening allergic reactions, skin reactions, or drug reactions, including exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, drug reaction with eosinophilia and systemic symptoms (see above section)
• Anemia
• Blood disorders
• Prolonged bleeding time
• Hyperkalemia (high potassium levels in the blood) 

Interactions

Before taking diclofenac, tell your healthcare provider if you have any allergies to medications. Tell your provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements.

Some examples of interactions with diclofenac include:

• Toradol (ketorolac) should not be taken with diclofenac. The combination of the two drugs can increase the risk of gastrointestinal ulcers, perforation, and bleeding, which could be life-threatening. Also, combining these two drugs could cause high blood pressure, kidney problems, and other complications. 
• Avoid consuming alcohol while taking diclofenac. The combination of diclofenac and alcohol can increase the risk of gastrointestinal ulcers, perforation, and bleeding, which could be life-threatening. 
• While taking diclofenac, avoid excessive caffeine intake. Excess caffeine could increase the risk of high blood pressure.
• Diuretics, or water pills, combined with diclofenac, can increase the risk of kidney problems. If the combination of diclofenac and a diuretic cannot be avoided, the prescriber will closely monitor kidney function.
• Diclofenac can increase the risk of bleeding when combined with certain medications, including blood thinners, antiplatelet drugs, selective serotonin reuptake inhibitor (SSRI) antidepressants, or serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants. Patients who take a combination of one of these drugs with diclofenac will be closely monitored for bleeding. 
• Diclofenac may interact with angiotensin receptor blockers (ARBs), ACE inhibitors, or beta-blockers. These drugs may not be as effective in controlling blood pressure when taken with diclofenac. In some cases, the combination could worsen kidney function or even cause kidney failure. If one of these drugs must be used with diclofenac, depending on risk factors, the healthcare provider will regularly monitor blood pressure and kidney function and ensure that the patient is adequately hydrated. 

Other drug interactions may occur. Consult your physician for more information about drug interactions with diclofenac.

Diclofenac alternatives 

For mild to moderate pain, when a patient cannot take or tolerate an NSAID, Tylenol (acetaminophen) may be a safer option. Although high Tylenol doses can cause liver problems, Tylenol does not carry the same risks as NSAIDs in terms of stomach and heart problems.

In some cases, a patient may want to try a different NSAID, if diclofenac is not effective enough for symptom relief. Examples of other NSAIDs include:

• Advil, Motrin (ibuprofen): This is available OTC, and as a prescription in higher strengths
• Aleve, Anaprox, Naprosyn (naproxen): These forms of naproxen are also available both OTC and by prescription
• Celebrex (celecoxib)
• Mobic (meloxicam)
• Relafen (nabumetone)

For more severe or chronic pain, healthcare professionals may prescribe a stronger medication such as an opioid pain medicine.

Consult your healthcare provider about which medication is right for you. There are many factors to consider in choosing the most appropriate medication, including age, symptoms, medical history, risk factors, and other medications you take.

Diclofenac savings

To save on diclofenac, choose generic. The generic version is just as effective as the brand, and costs considerably less. Always check the SingleCare website for free coupons and cards—using SingleCare can save up to 80% on the cost of your prescriptions. What’s more, you can use the coupons on future refills of diclofenac—as well as any other medications you take. Ask your pharmacist to compare prices and start saving.