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Diclofenac - Uses, Dosage, Side Effects, Drug Warnings, and Precautions

Published on Feb 26, 2022 and last reviewed on Oct 13, 2022   -  11 min read

Abstract

Diclofenac is a non-opioid analgesic used to relieve pain, fever, and inflammatory diseases. Learn about its uses, dosage, drug warnings, side effects, precautions, drug interactions, and more.

Diclofenac  - Uses, Dosage, Side Effects, Drug Warnings, and Precautions

Overview:

Diclofenac is a prescription medicine that belongs to the non-steroidal anti-inflammatory class of drugs. It helps to relieve pain, stiffness, tenderness, swelling caused by osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, and also helps in fever, inflammation, migraine headaches, menstrual pain, etc. This drug is available in injection, and topical forms, and some of them are oral tablets, extended-release tablets, delayed-release tablets, capsules, powdered form (packets), oral liquid-filled capsules (liquid-gels), enteric-coated tablet, topical cream, patch, topical gel, topical spray, solutions, and topical stick.

Composition:

Systemic Diclofenac-

This tablet contains,

  1. Active Ingredient:Diclofenac sodium.

  2. Inactive Ingredients:

  • Aerosil.

  • Microcrystalline cellulose.

  • Magnesium stearate.

  • Mannitol.

  • Hypromellose.

  • Croscarmellose sodium.

  • Sodium dodecyl sulfate.

  • Amide.

Topical Diclofenac-

This cream contains,

1. Active Ingredient: Diclofenac sodium.2. Inactive Ingredients:

  • Propyl hydroxybenzoate.

  • Methyl hydroxybenzoate.

  • Propylene glycol.

  • Hydroxyethylcellulose.

  • Carbomers.

  • Median chain triglycerides.

  • Mineral oil.

  • Isopropyl alcohol.

  • Purified water.

Drug Group:

Diclofenac belongs to the class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs) or non-opioid analgesics. It stops the body from producing substances that cause fever, pain, and inflammation. Thus, Diclofenac helps to relieve symptoms of mild to moderate pain, swelling, tenderness, redness, menstrual pain, etc.

What Is Diclofenac Used For?

The uses of Diclofenac are as follows,

  1. It helps to relieve pain, inflammation, tenderness, and joint stiffness caused by,

  • Osteoarthritis (arthritis caused by a breakdown of the lining of the joints).

  • Rheumatoid arthritis (arthritis caused by swelling of the lining of the joints).

  • Musculoskeletal disorders.

  • Soft tissue injury.

  • Ankylosing spondylitis (arthritis that mainly affects the spine).

  • Fractures.

  • Vasectomy.

  • Postpartum.

  • Dysmenorrhoea.

2. In Dentistry: It helps to relieve pain in procedures such as,

  • Impaction.

  • Open extraction.

  • Traumatic occlusions, etc.

3. Intramuscularly – It is used for post-operative pain instead of opioids and is commonly used in dentistry.

4. It helps to relieve pain in post-traumatic or operative inflammatory conditions quickly.

5. It helps to reduce the inflammation in rheumatoid arthritis and in extended therapeutic action on joints.6. It helps in the closure of ductus arteriosus.7. Prevention of colon cancer.8. In familial colonic polyposis, it gives symptomatic relief and suppresses polyp formation.9. Relieves painful menstrual periods.10 Helps with migraine headaches.

How Does Diclofenac Work?

Diclofenac reversibly inhibits the enzyme cyclooxygenase 1 and 2. It is responsible for the production of prostaglandin (PG), which has broad activity in pain and inflammation and thereby inhibits the synthesis of prostaglandins, that is, inhibiting the production of pain and inflammation.

Onset Of Action:

Diclofenac is well absorbed orally. It is metabolized in the liver and excreted via bile (40 %) and urine (60 %). The onset of action is 30 minutes for oral tablets and 4 hours on topical application. It reaches its peak plasma concentration within 10 to 40 minutes of drug intake. The enteric-coated tablet takes 1.5 - 2 hours to reach peak plasma concentration.

Expiry Date:

Avoid taking this medicine after it expires. Diclofenac does not work and may lead to serious side effects when it is used beyond the expiry date. So before taking medicine, verify the expiry date printed on the back of the pack or ask your pharmacist or doctor in case of any doubts.

What Is the Dosage and Administration of Diclofenac?

A. Systemic Diclofenac:

Dosage and Administration of Diclofenac

B. Topical Diclofenac:

1. In order to measure the correct dose:

  • Use the dosing card(s) which will be provided with the medication.
  • Read the instructions present on the dosing card.
  • Squeeze the medicine from the tube on the dosing card and measure the prescribed dose using the marks on the card.
  • Gently rub the medicine on the affected joint four times daily or as directed by the doctor.
  • You should not apply the medicine on skin that has infections, cuts, or rashes.

2. You should not apply more than 15 grams of Diclofenac per day to a single joint such as the knee, foot, ankle (lower part of the body).

3. Likewise, do not apply more than 7 grams of Diclofenac per day to a single joint of the hand, elbow, wrist (upper part of the body). No matter how many joints are treated, Diclofenac should not be used more than 32 grams per day.

How to Use Diclofenac?

A. Systemic Diclofenac:

1. You should read all directions on the package label before using this medicine. When you have any doubts or questions, consult your doctor or pharmacist.

2. Take the medication by mouth with a glass full of water; when the doctor has prescribed the medicine, you should take it as directed by the doctor.

3. It is not advisable to lie down for at least 10 minutes after taking Diclofenac.

4. When you experience stomach upset on taking this medication, you can take it with milk, food, or an antacid.

5. This drug will start to absorb slowly, and there will be a delay in pain relief when you are not taking it on a regular schedule or as directed by the doctor.

6. Diclofenac should be swallowed as a whole and should not be crushed, chewed, or broken before usage because the special coating on the tablet will be broken and may increase the side effects.

7. In order to minimize side effects such as stomach bleeding:

  • You should use this medication at the lowest effective dose for a short period of time.
  • You should not increase the dose or use it more often than prescribed.
  • For arthritis, continue taking this drug as directed by the doctor.

8. The drug should be taken for up to 2 weeks in case of arthritis to obtain the full benefits of the drug.

9. The drug will effectively work when used only on a needed basis and will take time to work when it is used when the symptoms get worse.

B. Topical Diclofenac:

  1. Diclofenac should be used only on the skin.

  2. Wash your hands immediately after usage of the drug, and do not use this medicine for large areas of the body or more than recommended times. This will not cure the condition faster; instead, it improves the chances of risk.

  3. You should not bathe or wash the treated areas for at least one hour after the application of the medicine. Wait for at least 10 minutes before covering the area with gloves or clothing, and do not wrap, bandage, or heating pad to the treated area.

  4. Also, avoid the product entering the eyes, ears, nose, or mouth. If it gets in these areas unknowingly, rinse the area or wipe it right away with water.

  5. You should use this medication at the lowest effective dose for a short period of time.

  6. You should not increase the dose or use it more often than prescribed.

  7. The drug should be taken for up to 2 weeks in case of arthritis to obtain the full benefits of the drug.

  8. If you have any doubts, kindly ask the doctor or pharmacist before using them.

Missed Dose:

It is important to take the missed dose as soon as you remember it, but if it is almost time for the next dose, you can skip the missed dose and start continuing with the regular dosing schedule. In order to compensate for a missed one, do not take a double dose.

What Are the Drug Warnings and Precautions?

1. Before using Diclofenac, inform your doctor or pharmacist if you have been allergic to this medicine or aspirin or other NSAIDs. This drug contains inactive ingredients, which may cause allergic reactions or any other problems. So, it is always better to speak to the doctor or pharmacist to know more information.

2. Avoid increasing the dose by yourself or taking this medication more often than directed by the pharmacist or doctor because the dosage depends on age, response to the treatment, and medical condition.

3. Before using Diclofenac, you should tell your doctor or pharmacist about your medical history (present and previous), especially of,

Breathing problems:

  1. Asthma.
  2. Aspirin-sensitive asthma.
  • Bleeding problems.
  • Heart problems.
  • High blood pressure.
  • Liver disease.
  • Stroke.
  • Nasal polyps.

Stomach problems:

  1. Ulcers.
  2. Bleeding.
  3. Recurring heartburns.

4. Kidney problems occur due to the use of NSAIDs and most commonly occurs when the patient is dehydrated.

5. The drug can make you dizzy. So, do not use machinery, or drive, or do anything that needs more consciousness until you can safely do it.

6. Stop the daily usage of tobacco, alcohol, and smoking as it can increase the risk of stomach bleeding.

7. Diclofenac makes the skin more sensitive to the sun, so limit the time in the sun and use sunscreen; wear protective clothing when stepping out.

8 Speak to the doctor when you get sunburn or redness, or skin blisters.

9. Before any surgery, tell your doctor or dentist about all the prescription, nonprescription and herbal products you use to avoid future complications.

10. Women of childbearing age should talk to the doctor before taking medicine as it may cause problems when planning to get pregnant.

11. At the time of pregnancy, this medicine should be used between 20 to 30 weeks of pregnancy and should not be used after 30 th week of pregnancy; also, discuss the risks and benefits of this medicine before usage with your doctor.

12. It is said that this medication passes into breast milk, so consult with your doctor before breastfeeding.

What Are the Side Effects of Diclofenac?

1. Systemic Diclofenac-

  • Common Side Effects:

The following are the common side effects of systemic Diclofenac, and you should seek a doctor if it worsens and persists for a longer time.

  • Stomach upset.

  • Nausea.

  • Heartburn.

  • Diarrhea.

  • Constipation.

  • Gas formation.

  • Headache.

  • Drowsiness.

Serious Side Effects:

Systemic Diclofenac can cause serious side effects, and when you experience any of the following side effects, stop the drug and get emergency medical help.

  • Ringing in the ears.

  • Mood changes.

  • Difficulty in swallowing.

  • Symptoms of heart failure.

  • Swelling of ankles or feet.

  • Unusual tiredness.

  • Unusual weight gain.

  • Labor and Pregnancy: if used near or during labor, premature closure of ductus arteriosus occurs and prolongs labor.

2.Topical Diclofenac-

  • Common Side Effects:

The following are the common side effects of topical Diclofenac, and you should seek a doctor if it worsens and persists for a longer time.

  • Skin rash.

  • Redness.

  • Photosensitivity.

  • Serious Side Effects:

Topical Diclofenac does not cause serious side effects but seek a doctor if you experience any of the following symptoms.

  • Rashes.

  • Itching.

  • Swelling of the face, tongue, or throat.

  • Severe dizziness.

  • Trouble breathing.

3. Rare Side Effects That Occur via Oral and Topical-

  • Liver Problem:

Immediate emergency medical help is needed when you experience symptoms of liver damage (rare),

  • Dark urine.

  • Persistent nausea.

  • Vomiting.

  • Loss of appetite.

  • Stomach pain.

  • Yellow eyes or skin.

Allergic Reactions:

A severe allergic reaction to this drug is rare, but when you notice any symptoms of a serious allergic reaction, reach a doctor.

  • Rashes.

  • Itching.

  • Swelling of the face, tongue, or throat.

  • Severe dizziness.

  • Trouble breathing.

  • Urticaria.

  • Precipitation of asthma.

  • Angioedema.

  • Anaphylaxis.

Kidney Problems:

  • Change in the amount of urine.

  • Unexplained stiff neck.

  • Edema.

  • Nephropathy.

  • Hyperkalemia.

GIT (Gastrointestinal Tract):

  • Peptic ulcer.

  • Epigastric pain.

  • Erosions.

  • Gastritis.

  • Esophagitis.

  • Bleeding.

  • Perforation.

Antiplatelet Action:

  • Bleeding from GIT, skin, nose, and intracranium.

  • Cardiovascular System:

  • Edema.

  • Rise in blood pressure.

  • Rarely congestive heart failure.

In Children:

Children with viral infections can face serious side effects such as,

  • Chickenpox.

  • Influenza.

  • Reye's Syndrome (brain and liver damage).

What Are the Interactions of Diclofenac?

1. Drug interactions may change the mechanism and effectiveness of the drug; also, they increase the risk of serious side effects. So, it is better to inform your doctor about all the prescription, nonprescription and herbal drugs you are taking.

2. Do not stop or change the dosage of the drug by yourself; always ask your doctor's approval before changing the dosage of the drug.

3. Ask for any doubts to your doctor or pharmacist about using the products safely.

4. Some of the products that interact with Diclofenac are,

  1. Aliskiren.

  2. ACE inhibitors:

    • Captopril.

    • Lisinopril.

  3. Angiotensin 2 receptor blockers:

    • Valsartan.

    • Losartan.

  4. Corticosteroids:

    • Prednisone.

  5. Cidofovir.

  6. Beta-blockers:

    • Propranolol.

  7. Lithium.

  8. Methotrexate.

  9. Diuretics (water pills):

    • Furosemide.

  10. Digoxin.

  11. Cyclosporine.

  12. Pemetrexed.

5. Always inform the doctor or pharmacist about the other products you are taking, as some medications can increase the risk of bleeding when taken with other drugs. They are,

  1. Antiplatelet drugs:

    • Clopidogrel.

  2. Blood thinners:

    • Dabigatran.

    • Enoxaparin.

    • Warfarin.

6. Check all the prescription and nonprescription labels carefully because most of the medications contain pain relievers or fever reducers such as,

1. Aspirin.

2. Salicylates:

  • Diflunisal.

  • Salsalate.

3. NSAIDs:

  • Celecoxib.

  • Ibuprofen.

  • Ketorolac.

These drugs are similar to Diclofenac, and they will increase the risk of side effects when taken together.

7. Suppose when the doctor has directed to take low-dose Aspirin to prevent heart attack or stroke; in that case, continue taking the Aspirin unless the doctor instructs. For more details, speak to the doctor or pharmacist.

8. Always keep a list of all the products you are taking and share it with the doctor or pharmacist to reduce the risk of serious drug interactions.

What Are the Common Brands or Trade Names of Diclofenac?

The common brand names of Diclofenac are,

Systemic Diclofenac:

  • Cambia.

  • Voltaren.

  • Zipsor.

  • Voltaren-XR.

  • Zorvolex.

  • Cataflam.

  • Dyloject.

Topical Diclofenac:

  • Voltaren.

  • Flector.

  • Rexaphenac.

  • Pennsaid.

  • Solaraze.

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Last reviewed at:
13 Oct 2022  -  11 min read

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