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Diclofenac



(dye kloe' fen ak)

Cambia®
Cataflam®¶
Voltaren XR®¶
Zipsor®
Zorvolex®

People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as diclofenac may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Do not take an NSAID such as diclofenac if you have recently had a heart attack, unless directed to do so by your doctor. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.
If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take diclofenac right before or right after the surgery.
NSAIDs such as diclofenac may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or drink large amounts of alcohol while taking diclofenac. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking diclofenac and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to diclofenac. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with diclofenac and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the Medication Guide.

Transdermal diclofenac is used to treat short-term pain due to minor strains, sprains, and bruises. Diclofenac is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body's production of a substance that causes pain.

Diclofenac comes as a tablet, and liquid-filled capsule, a hard gelatin capsule, an extended-release (long-acting) tablet, a delayed-release (releases medication in the intestine) tablet, and as packets of powder for solution (to be mixed with water) and take by mouth. Diclofenac liquid-filled capsules are usually taken 4 times a day and diclofenac hard gelatin capsules are usually taken three times a day on an empty stomach. Diclofenac extended-release tablets are usually taken once a day, and in rare cases are taken twice a day, if needed to control pain. Diclofenac tablets and diclofenac delayed-release tablets are usually taken 2, 3, or 4 times a day. Diclofenac solution is taken without food as a one dose treatment to relieve the pain of migraine headaches. If you were told to take diclofenac on a regular basis, take it at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take diclofenac exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Different diclofenac products release the medication differently in your body and cannot be used interchangeably. Only take the diclofenac product prescribed by your doctor and do not switch to a different diclofenac product unless your doctor says that you should.
Your doctor may adjust the dose of your medication during your treatment depending on your response to the medication. Talk to your doctor about how you are feeling during your treatment with diclofenac.
If you are taking the powder for solution, you will need to mix it with water before you take it. To mix the medication, first remove one packet from a row of three attached packets. Place 2 to 4 tablespoons (1 to 2 ounces; 30 to 60 mL) of water in a cup. Add the contents of the packet and mix well. Drink the entire mixture right away. Throw away the empty packet in a trash can that is out of the reach of children and pets.

Before using diclofenac patches,

tell your doctor and pharmacist if you are allergic to diclofenac (Cambia, Pennsaid, Solaraze, Voltaren, Zipsor, Zorvolex, in Arthrotec), aspirin, or other NSAIDs; any other medications; or any of the other ingredients in diclofenac patches. Ask your pharmacist or check the Medication Guide for a list of the ingredients. Tell your doctor and pharmacist if you have asthma, growths in your nose, or an ongoing runny nose and if you have had an asthma attack, hives, difficulty breathing or swallowing, or an allergic reaction after taking aspirin, an aspirin-containing product, or any other NSAID medication. Your doctor will probably tell you not to use diclofenac patches.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: acetaminophen (Tylenol, other products); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Zestoretic), moexipril (Univasc, in Uniretic); perindopril (Aceon, in Prestalia), quinapril (Accupril, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); angiotensin receptor blockers such as candesartan (Atacand, in Atacand HCT), eprosartan (Teveten), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, in Benicar HCT, in Tribenzor), telmisartan (Micardis, in Micardis HCT, in Twynsta), and valsartan (in Exforge HCT); certain antibiotics; beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal, Innopran); cyclosporine (Gengraf, Neoral, Sandimmune); diuretics ('water pills'); lithium (Lithobid); medications for seizures; and methotrexate (Otrexup, Rasuvo, Trexall). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have severe diarrhea or vomiting or think you may be dehydrated, if you drink or have a history of drinking large amounts of alcohol, and if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section, heart failure; swelling of the hands, feet, ankles, or lower legs; or kidney or liver disease.

tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, you plan to become pregnant, or you are breast-feeding. If you become pregnant while using diclofenac patches, call your doctor.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are using diclofenac patches.

you should know that during treatment with diclofenac patches it may be harder to know if you have an infection or illness because this medication may also lower or prevent fever. Call your doctor if you are not feeling well or have other signs of an infection or illness.

Unless your doctor tells you otherwise, continue your normal diet.

Apply a new patch as soon as you remember it. However, if it is almost time for the next scheduled application, skip the missed dose and continue your regular schedule. Do not apply an extra diclofenac patch to make up for a missed dose.

Transdermal diclofenac may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:



dryness, redness, itching, swelling, irritation, or numbness at application site

changes in taste

headache

sleepiness

tingling skin

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:



hives

itching

difficulty swallowing

swelling of the face or throat, arms, or hands

unexplained weight gain

shortness of breath or difficulty breathing

swelling in the abdomen, ankles, feet, or legs

wheezing

worsening of asthma

yellowing of the skin or eyes

nausea

extreme tiredness

unusual bleeding or bruising

lack of energy

loss of appetite

pain in the upper right part of the stomach

flu-like symptoms

dark-colored urine

rash

blisters on skin

fever

pale skin

fast heartbeat
Diclofenac patches may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.  However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community.  See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
¶ This branded product is no longer on the market. Generic alternatives may be available.