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Diclofenac 

Diclofenac

Diclofenac is a powerful nonsteroidal anti-inflammatory drug (NSAID) that is used to manage pain and inflammation linked to various conditions, including osteoarthritis, rheumatoid arthritis, migraines, and ankylosing spondylitis. This FDA-approved medication functions by inhibiting the cyclooxygenase (COX) enzymes, which are crucial in producing prostaglandins that trigger pain and inflammation. Diclofenac offers flexible dosing options tailored to patient needs, available in various forms, including tablets, topical gels, and injections. While generally safe for adults, it requires cautious use in elderly patients and those with pre-existing health conditions. Side effects can range from mild, such as dizziness and stomach upset, to more severe, such as cardiovascular issues or gastrointestinal bleeding. Taking Diclofenac with food or milk is essential to mitigate stomach discomfort and adhere strictly to prescribed dosages to avoid potential risks. Always consult a healthcare provider for personalized guidance and to manage the dosage effectively.

Product Overview

Diclofenac is a potent nonsteroidal anti-inflammatory drug (NSAID) primarily used to reduce inflammation and relieve pain. The main ingredient in Diclofenac is a powerful agent that targets pain at its source by inhibiting enzymes involved in inflammation. This medication is FDA-approved and is commonly prescribed for conditions such as osteoarthritis, rheumatoid arthritis, mild to moderate pain, migraines, and ankylosing spondylitis. Diclofenac works by blocking the cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2, which play a key role in producing prostaglandins that promote inflammation, pain, and fever.

Diclofenac is available in various strengths and forms, including tablets, topical gels, and injections, making it adaptable to different patient needs. Adults typically take 50 mg two or three times a day for pain and inflammatory conditions. At the same time, topical forms like 1% gel can be applied to affected areas for localized action without systemic effects. It is suitable for adults and, with caution, for elderly patients needing adjusted doses. The drug’s mechanism involves the reduction of prostaglandin synthesis, thereby easing symptoms of inflammation and pain.

However, Diclofenac can cause side effects such as dizziness, stomach upset, and more serious ones like heart problems or gastrointestinal bleeding. To minimize stomach discomfort, patients are advised to take Diclofenac with food or milk. It is crucial to adhere to prescribed dosages to avoid adverse effects. In case of a missed dose, it should be taken as soon as remembered unless it is near the time for the next dose. For overdoses, immediate medical attention is necessary. Diclofenac should be stored at room temperature, away from excess heat and moisture. Users need to follow their doctor’s guidance and warnings, particularly regarding potential drug interactions and contraindications with other NSAIDs or medications.

Uses of Diclofenac

  • Osteoarthritis
  • Menstrual cramps
  • Mild to moderate pain
  • Rheumatoid arthritis
  • Migraine attacks
  • Ankylosing spondylitis (arthritis of the spine)

How to Use Diclofenac?

Dosage

Diclofenac comes in multiple forms and strengths like:

  • Tablets (Immediate-Release): 25 mg and 50 mg.
  • Tablets (Enteric-Coated): 25 mg, 50 mg, and 75 mg.
  • Tablets (Extended-Release): 100 mg.
  • Topical Gel: 1% Diclofenac sodium gel.
  • Topical Solution: 1.5% (for knee pain) and 2% (for osteoarthritis of the hand).
  • Topical Cream: 1% Diclofenac sodium cream.
  • Topical Patch: 1.3% Diclofenac sodium.
  • Eye Drops: 0.1% for treating postoperative inflammation.
  • Injectable Solution: 75 mg/ml for intramuscular injection.

Recommended Dosage for Different Patients

Osteoarthritis:

  • Diclofenac free acid capsules: 35 mg orally three times a day.
  • Diclofenac potassium immediate-release tablets: 50 mg orally two to three times a day.
  • Diclofenac sodium enteric-coated tablets: 50 mg orally two to three times a day or 75 mg orally twice daily.
  • Maximum daily dose: 150 mg.

Ankylosing Spondylitis:

  • Diclofenac sodium enteric-coated and delayed-release tablets: 25 mg orally four times a day, with an optional additional 25 mg dose at bedtime if necessary.
  • Maximum daily dose: 125 mg.

Dysmenorrhea (Menstrual Pain):

  • Diclofenac potassium immediate-release tablets: 50 mg orally three times a day. For better relief, an initial dose of 100 mg orally followed by 50 mg doses can be taken. Treatment should start with the first symptoms and continue for a few days.

Rheumatoid Arthritis:

  • Diclofenac potassium immediate-release tablets: 50 mg orally three to four times a day.
  • Diclofenac sodium enteric-coated and delayed-release tablets: 50 mg orally three to four times daily or 75 mg orally twice daily.
  • Maximum daily dose: 225 mg.

Migraine (Acute Treatment):

  • Diclofenac potassium for oral solution packets: 50 mg (1 packet) taken orally once. This medication is not recommended for the prophylactic therapy of migraines or for treating cluster headaches.

[Note: Remember these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

Diclofenac Tablets (Immediate-Release, Enteric-Coated, and Extended-Release)

  • Take Diclofenac with food or immediately after a meal to reduce stomach upset. For enteric-coated tablets, do not crush or chew them, as this can destroy the protective effect of the coating designed to prevent stomach irritation.
  • Follow the dosage prescribed by your healthcare provider, typically ranging from 50 to 100 mg daily, depending on the treated condition and the specific product.
  • Swallow the tablets whole with a full glass of water to ensure complete ingestion of the medication.
  • Take Diclofenac at the same times each day to maintain an even level of medication in your body.

Diclofenac Topical Gel, Cream, and Patch

  • Clean and dry the area to which the medication will be applied.
  • Use only the amount your healthcare provider directs, spreading it thinly over the affected area.
  • After applying diclofenac gel or cream, wash your hands thoroughly unless the hands are in the treated area.
  • Unless directed by your doctor, do not cover the treated area with a bandage or expose it to heat from sources like heating pads.

Diclofenac Eye Drops

  • Do not touch the dropper tip or let it touch your eye or any other surface to prevent contamination.
  • Tilt your head back, pull down your lower eyelid, and drop the medicine into the pouch. Close your eyes gently for 1 to 2 minutes.
  • If you need to apply more than one drop, wait about 5 minutes between drops.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Diclofenac Work?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting enzymes known as cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These enzymes play a key role in synthesizing prostaglandins, which are chemicals in the body responsible for pain, inflammation, and fever. By blocking the activity of these enzymes, Diclofenac effectively reduces the levels of prostaglandins. This leads to decreased inflammation, pain, and fever, effectively treating conditions like arthritis, menstrual cramps, and other inflammatory disorders. However, the suppression of prostaglandins can also cause side effects, particularly in the gastrointestinal tract and cardiovascular system.

Important Safety Information

Side Effects

Common side effects of this medication may include:

  • Dizziness
  • Fluid retention (buildup)
  • Hair loss
  • Heartburn
  • Itchy skin
  • Headache
  • Diarrhea
  • Feeling sleepy
  • Gas
  • Nausea and vomiting
  • Upset stomach
  • Abdominal pain
  • Mild allergic reaction*

Serious side effects of this medication may include:

  • Severe allergic reactions, including intense skin responses
  • Mood alterations, encompassing symptoms of anxiety and depression
  • Cardiovascular issues, heightened risk of complications*
  • Respiratory difficulties, like asthma or shortness of breath
  • Blood cell count changes, notably thrombocytopenia (low platelet level)
  • Gastrointestinal risks, including increased bleeding and the development of ulcers and holes in the stomach and intestines*
  • Renal concerns, such as kidney failure
  • Liver conditions, including liver failure
  • Heart-related problems, such as high blood pressure or heart failure

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

  • Avoid using Diclofenac if you have previously had allergic reactions to aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs).
  • There is an increased risk of fatal heart attacks or strokes associated with Diclofenac, particularly with long-term use, high doses, or pre-existing heart disease. Avoid use immediately before or after heart bypass surgery (coronary artery bypass graft, or CABG).
  • Diclofenac may cause stomach or intestinal bleeding, which can be life-threatening. These conditions can develop unexpectedly during use, especially in older adults.

Precautions

Before Taking Diclofenac:

  • Inform your doctor or pharmacist if you are allergic to Diclofenac, aspirin, or other NSAIDs (such as ibuprofen, naproxen, or celecoxib) or if you have other allergies.
  • This medication may contain inactive ingredients that can cause allergic reactions or other issues.

Medical History:

  • Discuss your medical history with your healthcare provider, especially if you have had:
    • Asthma, particularly if NSAIDs worsen your breathing.
    • Blood disorders like anemia or bleeding/clotting problems.
    • Nasal polyps.
    • Heart disease, including previous heart attacks.
    • High blood pressure.
    • Liver disease.
    • History of stroke.
    • Swelling or fluid retention.
    • Stomach, intestinal, or esophagus issues such as bleeding, heartburn, or ulcers.

Risk of Kidney Problems:

  • Kidney issues can arise with NSAID use, especially if you are dehydrated, have heart failure or kidney disease, are an older adult, or take certain other medications.
  • Stay hydrated to prevent dehydration, and notify your doctor immediately if you notice changes like pink/bloody urine or unusual changes in urine volume.

Side Effects:

  • This drug may cause dizziness, drowsiness, or blurred vision.
  • Consuming alcohol or marijuana can intensify these effects.
  • Avoid driving or operating machinery until you can safely perform such activities.
  • Limit alcohol intake and quit smoking to reduce the risk of stomach bleeding.
  • This medication increases sensitivity to sunlight, limits sun exposure, and prevents tanning booth use. Therefore, it is recommended that you use sunscreen and protective clothing outdoors.

Surgical Considerations:

  • Inform your doctor or dentist about all the products you use (including prescription/nonprescription drugs and herbal products) before surgery.

Additional Risks for Older Adults:

  • Increased risk of stomach/intestinal bleeding, kidney problems, heart attack, and stroke.

Pregnancy and Breastfeeding:

  • Women of childbearing age should discuss the benefits and risks with their doctor.
  • Not recommended from 20 weeks until delivery due to potential harm to the unborn baby and complications during labor.
  • Use only if necessary between 20-30 weeks of pregnancy and at the lowest effective dose for the shortest duration.
  • Do not use it after 30 weeks of pregnancy.
  • Diclofenac passes into breast milk; consult your doctor before breastfeeding.

Contraindications

Contraindications refer to specific conditions or circumstances where taking a medication like Diclofenac is not advised due to safety risks. Before using Diclofenac, inform your healthcare provider if any of the following apply to you, as it may not be safe for you:

  • A history of asthma, hives, or other allergic reactions triggered by aspirin or other NSAIDs.
  • Use of Diclofenac is contraindicated for 10 to 14 days following open heart surgery.
  • Allergy to bovine (cow) products, which is particularly relevant for Diclofenac potassium (Zipsor) capsules.

Missed Dose

If you forget to take a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the one you missed. Continue with your regular dosing schedule and avoid doubling up on doses to make up for the missed one.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose 

In the event of an overdose where serious symptoms such as unconsciousness or difficulty breathing occur, immediately call for medical help. Symptoms of an overdose can include severe stomach pain, slow or shallow breathing, and profound drowsiness.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

Storage

  • Oral Route (Tablets and Capsules):
      • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
      • Keep it from freezing.
      • Keep it out of the reach of children.
      • Do not keep outdated medicine or medicine no longer needed.
      • If you have any unused medicine, ask your healthcare professional how you should dispose of it.
  • Injection for IV use:
    • Protect it from light.
    • Do not freeze.
    • Store it at controlled room temperature (20°C to 25°C or 68°F to 77°F)

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Diclofenac Interactions

  • Anticoagulants (Blood Thinners) – such as warfarin and heparin- increase the bleeding risk.
  • Antiplatelet Drugs – like aspirin and clopidogrel, which may enhance the risk of bleeding.
  • Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) – drugs like fluoxetine, sertraline, and venlafaxine can increase bleeding risk.
  • Other NSAIDs – including ibuprofen naproxen, which can increase the risk of gastrointestinal bleeding and ulcers.
  • Corticosteroids – such as prednisone, which can also elevate the risk of gastrointestinal ulceration or bleeding.
  • ACE Inhibitors and ARBs – e.g., lisinopril, losartan; Diclofenac may reduce the effectiveness of these drugs used to manage blood pressure and can worsen kidney function.
  • Diuretics – like furosemide and hydrochlorothiazide, can lead to kidney problems and reduce the diuretic effect.
  • Lithium – Diclofenac can increase lithium levels in the blood, leading to lithium toxicity.
  • Methotrexate – This medication can increase methotrexate levels, potentially leading to toxicity.
  • Cyclosporine – An increased risk of nephrotoxicity when used with Diclofenac.
  • Digoxin – Diclofenac can raise digoxin levels, which may require monitoring and dosage adjustment.
  • Pemetrexed – It may increase the risk of pemetrexed-related side effects in patients treated with Diclofenac.

[Note: This isn’t a complete list, and there could be other drugs that interact with Diclofenac. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Diclofenac Alternatives

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long is it safe to take Diclofenac?

The duration for which you can safely take Diclofenac varies based on your specific health condition and the form of Diclofenac prescribed. It’s essential to consult your healthcare provider for personalized guidance on how long to use this medication. For instance, Diclofenac (Cambia) for treating migraine attacks typically requires only a single dose. Conversely, suppose you’re using Diclofenac tablets to manage arthritis. In that case, your healthcare provider might recommend taking it consistently for at least 1 to 2 weeks to evaluate its effectiveness in relieving pain and inflammation. Generally, it is advisable to use the lowest effective dose of Diclofenac for the shortest possible duration to minimize the risk of severe side effects, such as heart attacks or strokes.

How long does Diclofenac remain in your system?

Diclofenac typically takes between 5 to 10 hours to be mostly cleared from your body after a single dose. This estimate is based on the drug’s half-life, although individual factors such as other medications you are taking, your overall health, and the specific formulation of Diclofenac used can influence this duration. If you have additional questions about how long Diclofenac stays in your system, it’s important to discuss them with your healthcare provider.

Is it common to feel sleepy after taking Diclofenac?

While sleepiness is not a commonly reported side effect of Diclofenac, there are occasional reports of individuals feeling dizzy or drowsy after taking the medication. If you experience sleepiness while using Diclofenac, it’s advisable to consult with your healthcare provider. They can assess whether the drowsiness is linked to Diclofenac or possibly related to another medication or health condition.

Does Diclofenac function as a muscle relaxer?

No, Diclofenac is not a muscle relaxer; it is classified as a non-steroidal anti-inflammatory drug (NSAID). However, some forms of Diclofenac are FDA-approved to alleviate mild to moderate pain, which may include muscle pain. If you are experiencing muscle pain or tension, it’s important to discuss with your healthcare provider to determine the most appropriate treatment options for your condition.

Is it safe to take ibuprofen (Advil) alongside Diclofenac?

You should avoid taking Diclofenac in combination with other NSAIDs, including ibuprofen (Advil), naproxen (Aleve), and even topical forms such as Diclofenac (Voltaren) gel. Combining these medications increases the risk of serious side effects such as stomach bleeds, strokes, and heart attacks. NSAIDs are prevalent in many over-the-counter pain relievers and cold medicines. If you’re unsure whether a product contains an NSAID, it’s important to consult with your healthcare provider or pharmacist before using it.

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