Indications
Diclofenac is a pain and inflammation reliever. It is used for:
- Pain and swelling in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and gout attacks.
- Back pain, sprains, strains and other muscle and joint injuries.
- Period pain, dental pain and pain after surgery.
- Gel forms: local pain and swelling in muscles and joints, such as the knee or a sprained ankle.
- Eye drops: inflammation and pain after eye surgery, as prescribed by an eye doctor.
How It Works
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). It blocks enzymes called COX that make prostaglandins, chemicals that cause pain, swelling and fever.
Dosage and Administration
- Tablets (adults): usually 75 to 150 mg a day split into 2 or 3 doses, taken with or after food. Do not take more than 150 mg a day from all forms together.
- Sustained release tablets or capsules: usually 75 mg once or twice a day, or 100 mg once a day. Swallow whole; do not crush or chew.
- Suppositories: inserted into the back passage, within the same daily limit, as advised by the doctor.
- Injection: given into a muscle by a doctor or nurse, usually for a short time only.
- Gel: rub a thin layer gently onto the painful area 3 or 4 times a day. Wash hands afterwards. Do not apply to broken skin.
- Eye drops: as prescribed by the eye doctor.
Use the lowest dose that works for the shortest possible time. Children: only as prescribed.
Interactions
- Other NSAIDs, including Aspirin, Ibuprofen and Naproxen: more risk of stomach bleeding; do not combine.
- Warfarin and other blood thinners, Clopidogrel, corticosteroids such as Prednisolone, and antidepressants such as Sertraline: more risk of bleeding.
- Blood pressure medicines (ACE inhibitors, ARBs) and diuretics: their effect may fall and the kidneys can be harmed, especially in older or dehydrated people.
- Lithium, Methotrexate, Digoxin and Ciclosporin: their levels or side effects may rise.
Contraindications
- Allergy to diclofenac, or asthma, hives or runny nose brought on by Aspirin or other NSAIDs.
- Active stomach or duodenal ulcer, or past bleeding from the gut.
- Heart failure, heart disease, previous heart attack or stroke, or poor circulation in the legs.
- Severe kidney or liver disease.
- The last three months of pregnancy.
Side Effects
Common: stomach pain, heartburn, nausea, diarrhoea, wind, headache and dizziness. Gel may cause mild redness or itching of the skin. Injection may cause pain at the injection site.
Get urgent medical help for black or bloody stools, vomiting blood, chest pain, sudden weakness on one side of the body or slurred speech, shortness of breath, swelling of the face, lips or throat, a blistering or peeling skin rash, yellow skin or eyes, or passing much less urine than usual.
Pregnancy and Lactation
Avoid in pregnancy unless the doctor advises it. From 20 weeks it can affect the baby’s kidneys, and it must not be used in the last three months. Only small amounts pass into breast milk, and short-term use may be acceptable if the doctor agrees; do not apply the gel on the breast.
Precautions and Warnings
Take tablets with food. Use extra care in older people, and in those with high blood pressure, diabetes, high cholesterol, asthma, kidney or liver problems, or a history of stomach ulcers. Long-term use raises the risk of heart attack, stroke and stomach bleeding. Do not take other pain relievers that contain an NSAID at the same time. Keep the gel away from the eyes and avoid strong sunlight on treated skin.
Overdose
Too much can cause nausea, vomiting, stomach pain, stomach bleeding, drowsiness and, rarely, fits or kidney damage. Seek medical help at once.
Therapeutic Class
Non-steroidal anti-inflammatory drug (NSAID), pain reliever.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Do not freeze the gel, eye drops or injection. Throw away eye drops 4 weeks after opening.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.