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What is diclofenac?

Diclofenac is a non steroidal anti inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain inflammation.

Diclofenac is used to treat pain or inflammation caused by arthritis or ankylosing spondylitis.

Diclofenac powder (Cambia) is used to treat a migraine headache attack. Do not use this medication to treat a cluster headache.

Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Diclofenac may also be used for purposes not listed in this medication guide.
What is the most important information I should know about diclofenac?

This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use diclofenac just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.
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This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking diclofenac, especially in older adults.

Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Ask a doctor or pharmacist before using any cold, allergy, or other pain medicine. Medicines similar to diclofenac are contained in many combination medicines. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.
What should I discuss with my healthcare provider before taking diclofenac?

Do not use diclofenac just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.

This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking diclofenac, especially in older adults.

You should not use this medication if you are allergic to diclofenac, or if you have a history of allergic reaction to aspirin or other NSAIDs.

To make sure you can safely take diclofenac, tell your doctor if you have any of these other conditions:

a history of heart attack, stroke, or blood clot;

heart disease, congestive heart failure, high blood pressure;

a history of stomach ulcers or bleeding;

liver or kidney disease,

asthma;

polyps in your nose;

a bleeding or blood clotting disorder; or

if you smoke.

FDA pregnancy category D. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking diclofenac during the last 3 months of pregnancy may harm the unborn baby. Do not take diclofenac during pregnancy unless your doctor has told you to.

It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using diclofenac.

Do not give this medicine to a child younger than 18 years old without medical advice.
How should I take diclofenac?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

If you switch brands of diclofenac, your dose needs may change. Follow your doctor's instructions about how much medicine to take.

Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Dissolve the diclofenac powder (Cambia) with 1 to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Diclofenac powder works best if you take it on an empty stomach.

Call your doctor if your headache does not completely go away after taking Cambia. Do not take a second dose of diclofenac powder without your doctor's advice.

Do not crush, chew, or break an enteric-coated pill. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating.

If you use this medication long-term, your liver function will need to be checked with frequent blood tests. Visit your doctor regularly.

Store at room temperature away from moisture and heat.
What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, stomach pain, drowsiness, black or bloody stools, coughing up blood, shallow breathing, and fainting.
What should I avoid while taking diclofenac?

Ask a doctor or pharmacist before using any cold, allergy, or other pain medicine. Medicines similar to diclofenac are contained in many combination medicines. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid exposure to sunlight or tanning beds. Diclofenac can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Diclofenac side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using diclofenac and call your doctor at once if you have a serious side effect such as:

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

black, bloody, or tarry stools;

coughing up blood or vomit that looks like coffee grounds;

swelling or rapid weight gain, urinating less than usual or not at all;

nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

bruising, severe tingling, numbness, pain, muscle weakness;

neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions); or

severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

upset stomach, mild heartburn or stomach pain, diarrhea, constipation bloating, gas;

dizziness, headache, nervousness;

skin itching or rash;

blurred vision; or

ringing in your ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: diclofenac side effects (in more detail)
Diclofenac Dosing Information

Usual Adult Dose for Osteoarthritis:

Diclofenac: 50 mg orally 2 to 3 times a day or 75 mg orally twice a day. Doses greater than 150 mg/day are not recommended for osteoarthritis.

Diclofenac Extended-release: 100 mg orally once a day.

Usual Adult Dose for Ankylosing Spondylitis:

Diclofenac Sodium: 25 mg orally 4 times a day. An additional 25 mg dose may be administered at bedtime, if necessary.

Usual Adult Dose for Dysmenorrhea:

Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day, the total daily dose should generally not exceed 150 mg.

Diclofenac Potassium liquid filled capsules (Zipsor[R]) are only approved by the FDA for mild to moderate acute pain. The dosage for this product is 25 mg orally 4 times a day.

Usual Adult Dose for Pain:

Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day, the total daily dose should generally not exceed 150 mg.

Diclofenac Potassium liquid filled capsules (Zipsor[R]) are only approved by the FDA for mild to moderate acute pain. The dosage for this product is 25 mg orally 4 times a day.

Usual Adult Dose for Rheumatoid Arthritis:

Diclofenac: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day.

Diclofenac Extended-release: 100 mg orally once a day.

Doses greater than 225 mg/day are not recommended for rheumatoid arthritis.

Usual Adult Dose for Migraine:

For acute treatment of migraine without aura:

Diclofenac potassium for oral solution packets: Mix one packet (50 mg) with 1 to 2 ounces (30 to 60 mL) water in a cup and drink immediately.

Usual Pediatric Dose for Pain:

Children: 2 to 3 mg/kg/day orally in divided doses 2 to 4 times daily
Maximum dose: 200 mg daily.
What other drugs will affect diclofenac?

Ask your doctor before using an antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all other medications you use, especially:

a blood thinner such as warfarin (Coumadin, Jantoven);

cyclosporine (Gengraf, Neoral, Sandimmune);

isoniazid (for treating tuberculosis);

lithium (Eskalith, Lithobid);

methotrexate (Rheumatrex, Trexall);

pronbenecid (Benemid);

rifampin (Rifadin, Rifater, Rifamate);

secobarbital (Seconal);

sertraline (Zoloft);

sulfamethoxazole (Bactrim, Septra, Sulfatrim, SMX-TMP, and others);

teniposide (Vumon);

zafirlukast (Accolate);

a diuretic (water pill) such as furosemide (Lasix).

steroids (prednisone and others);

antifungal medication such as fluconazole (Diflucan) or voriconazole (Vfend);

aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), indomethacin (Indocin), meloxicam (Mobic), and others;

cholesterol-lowering medicine such as fenofibrate (Antara, Fenoglide, Lipofen, Lofibra, TriCor, Triglide), fluvastatin (Lescol), or lovastatin (Mevacor, Altoprev, Advicor); or

heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and others.

This list is not complete and other drugs may interact with diclofenac. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

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