Diclofenac

Diclofenac Brand Names

Cambia | Cataflam | Dyloject | EnovaRX | Flector | PENNSAID | REXAPHENAC | Solaravix | Solaraze | Voltaren | Voltaren Gel | Voltaren-XR | Zipsor | Zorvolex

What is Diclofenac

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) of the acetic acid chemical class. As with other NSAIDs, diclofenac also possesses analgesic and antipyretic properties.

All NSAIDs, including diclofenac, increase the risk for serious gastrointestinal adverse effects including bleeding, ulceration, and perforation of the stomach or intestines and may increase the risk for serious cardiovascular thrombotic events, myocardial infarction, and stroke.

The lowest effective diclofenac dose for the shortest possible duration is recommended, as the risk for adverse effects may increase with increased drug exposure.

Oral delayed-release diclofenac sodium tablets (Voltaren) were initially FDA-approved in 1988 for the treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

Subsequently, various dosage forms have been approved for the treatment of different types of pain or inflammation.

Indications

1. actinic keratosis
2. ankylosing spondylitis
3. arthralgia
4. bone pain
5. dysmenorrhea
6. headache
7. heterotopic ossification
8. migraine
9. mild pain
10. moderate pain
11. myalgia
12. ocular pain
13. osteoarthritis
14. photophobia
15. postoperative ocular inflammation
16. rheumatoid arthritis
17. severe pain

Side Effects

1. abdominal pain
2. abnormal dreams
3. acneiform rash
4. acute generalized exanthematous pustulosis (AGEP)
5. agranulocytosis
6. alopecia
7. amblyopia
8. anaphylactoid reactions
9. anemia
10. angioedema
11. anxiety
12. aplastic anemia
13. appetite stimulation
14. arrhythmia exacerbation
15. arthralgia
16. aseptic meningitis
17. asthenia
18. azotemia
19. back pain
20. blurred vision
21. cataracts
22. chest pain (unspecified)
23. chills
24. cirrhosis
25. colitis
26. coma
27. confusion
28. conjunctivitis
29. constipation
30. contact dermatitis
31. corneal deposits
32. corneal edema
33. corneal erosion
34. corneal opacification
35. cough
36. cystitis
37. depression
38. diaphoresis
39. diarrhea
40. diplopia
41. dizziness
42. drowsiness
43. dysgeusia
44. dyspepsia
45. dyspnea
46. dysuria
47. ecchymosis
48. edema
49. elevated hepatic enzymes
50. eosinophilia
51. epistaxis
52. eructation
53. erythema
54. esophageal stricture
55. esophageal ulceration
56. esophagitis
57. exfoliative dermatitis
58. fever
59. flatulence
60. fluid retention
61. flushing
62. gastritis
63. GI bleeding
64. GI perforation
65. glossitis
66. halitosis
67. hallucinations
68. headache
69. hearing loss
70. heart failure
71. hematemesis
72. hematuria
73. hemolytic anemia
74. hepatic failure
75. hepatic necrosis
76. hepatitis
77. hypercholesterolemia
78. hyperesthesia
79. hyperglycemia
80. hyperhidrosis
81. hyperkalemia
82. hyperkinesis
83. hypertension
84. hyperventilation
85. hypoesthesia
86. hypoglycemia
87. hyponatremia
88. hypotension
89. impotence (erectile dysfunction)
90. increased urinary frequency
91. infection
92. influenza
93. injection site reaction
94. insomnia
95. interstitial nephritis
96. iritis
97. irritability
98. jaundice
99. keratitis
100. lacrimation
101. laryngeal edema
102. laryngitis
103. lethargy
104. leukopenia
105. lymphadenopathy
106. maculopapular rash
107. malaise
108. melena
109. memory impairment
110. meningitis
111. migraine
112. muscle cramps
113. myalgia
114. myocardial infarction
115. nausea
116. nephrotic syndrome
117. night blindness
118. nightmares
119. nocturia
120. ocular discharge
121. ocular hypertension
122. ocular irritation
123. ocular pain
124. ocular pruritus
125. oliguria
126. oral ulceration
127. palpitations
128. pancreatitis
129. pancytopenia
130. paresthesias
131. peptic ulcer
132. peripheral vasodilation
133. pharyngitis
134. photosensitivity
135. platelet dysfunction
136. polyuria
137. porphyria
138. premature ventricular contractions (PVCs)
139. prolonged bleeding time
140. proteinuria
141. pruritus
142. psychosis
143. purpura
144. pyrosis (heartburn)
145. rash
146. renal failure (unspecified)
147. renal papillary necrosis
148. respiratory depression
149. rhinitis
150. seborrhea
151. seizures
152. sinus tachycardia
153. sinusitis
154. skin atrophy
155. skin discoloration
156. skin irritation
157. skin ulcer
158. Stevens-Johnson syndrome
159. stomatitis
160. stroke
161. syncope
162. thrombocytopenia
163. thromboembolism
164. tinnitus
165. toxic epidermal necrolysis
166. tremor
167. urticaria
168. vaginal bleeding
169. vasculitis
170. vertigo
171. vesicular rash
172. visual impairment
173. vomiting
174. weight gain
175. weight loss
176. xerophthalmia
177. xerosis
178. xerostomia

Monitoring Parameters

• LFTs
• serum creatinine/BUN

Contraindications

• accidental exposure
• acute bronchospasm
• acute myocardial infarction
• alcoholism
• anemia
• angina
• anticoagulant therapy
• asthma
• benzyl alcohol hypersensitivity
• bone marrow suppression
• bovine protein hypersensitivity
• breast-feeding
• burns
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• chemotherapy
• coagulopathy
• contact lenses
• coronary artery bypass graft surgery (CABG)
• coronary artery disease
• corticosteroid therapy
• Crohn’s disease
• dehydration
• diabetes mellitus
• eczema
• edema
• exfoliative dermatitis
• geriatric
• GI bleeding
• GI disease
• GI perforation
• heart failure
• heating pad
• hematological disease
• hemophilia
• hepatic disease
• hypertension
• hypovolemia
• immunosuppression
• infertility
• jaundice
• labor
• myocardial infarction
• nasal polyps
• neutropenia
• NSAID hypersensitivity
• occlusive dressing
• ocular exposure
• ocular surgery
• peptic ulcer disease
• peripheral vascular disease
• phenylketonuria
• porphyria
• pregnancy
• renal disease
• renal failure
• renal impairment
• reproductive risk
• rheumatoid arthritis
• salicylate hypersensitivity
• skin abrasion
• stroke
• sunlight (UV) exposure
• surgery
• systemic lupus erythematosus (SLE)
• tachycardia
• thrombocytopenia
• thromboembolism
• tobacco smoking
• ulcerative colitis
• urticaria

Interactions

• Abciximab
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetohexamide
• Acyclovir
• Adefovir
• Aldesleukin, IL-2
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Alpha-blockers
• Alteplase
• Altretamine
• Ambenonium Chloride
• Amikacin
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminolevulinic Acid
• Aminosalicylate sodium, Aminosalicylic acid
• Amiodarone
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amphotericin B
• Amphotericin B cholesteryl sulfate complex (ABCD)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B liposomal (LAmB)
• Anagrelide
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• Angiotensin-converting enzyme inhibitors
• Antithrombin III
• Antithymocyte Globulin
• Apalutamide
• Apixaban
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• Aprotinin
• Argatroban
• Arsenic Trioxide
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atazanavir
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• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
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• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azathioprine
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• Azilsartan
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• Bacitracin
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• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Benazepril
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendamustine
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• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Beta-blockers
• Betamethasone
• Betaxolol
• Betrixaban
• Bictegravir; Emtricitabine; Tenofovir Alafenamide
• Bismuth Subsalicylate
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• Bisoprolol
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• Bivalirudin
• Bleomycin
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• Calcium Phosphate, Supersaturated
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• Candesartan
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• Cannabidiol
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• Captopril
• Captopril; Hydrochlorothiazide, HCTZ
• Carbamazepine
• Carmustine, BCNU
• Carteolol
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• Dexamethasone
• Diazoxide
• Diflunisal
• Digoxin
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Dipyridamole
• Docetaxel
• Donepezil
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• Doravirine; Lamivudine; Tenofovir disoproxil fumarate
• Dorzolamide; Timolol
• Doxazosin
• Dronedarone
• Drospirenone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Drotrecogin Alfa
• Duloxetine
• Edoxaban
• Edrophonium
• Efalizumab
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• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Elexacaftor; tezacaftor; ivacaftor
• Eltrombopag
• Elvitegravir
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Emtricitabine; Tenofovir alafenamide
• Emtricitabine; Tenofovir disoproxil fumarate
• Enalapril, Enalaprilat
• Enalapril; Felodipine
• Enalapril; Hydrochlorothiazide, HCTZ
• Enoxaparin
• Entecavir
• Enzalutamide
• Eplerenone
• Epoprostenol
• Eprosartan
• Eprosartan; Hydrochlorothiazide, HCTZ
• Eptifibatide
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• Escitalopram
• Esmolol
• Esomeprazole; Naproxen
• Estramustine
• Ethacrynic Acid
• Ethanol
• Etodolac
• Etravirine
• Famotidine; Ibuprofen
• Fenofibric Acid
• Fenoldopam
• Fenoprofen
• Flavocoxid, Flavocoxid; Citrated Zinc Bisglycinate
• Floxuridine
• Fluconazole
• Fludarabine
• Fludrocortisone
• Flunisolide
• Fluorouracil, 5-FU
• Fluoxetine
• Fluoxetine; Olanzapine
• Flurbiprofen
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvastatin
• Fluvoxamine
• Fondaparinux
• food
• Formoterol; Mometasone
• Foscarnet
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Furosemide
• Gadoterate meglumine
• Galantamine
• Gallium Ga 68 Dotatate
• Ganciclovir
• Garlic, Allium sativum
• Gemfibrozil
• Gentamicin
• Ginger, Zingiber officinale
• Ginkgo, Ginkgo biloba
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Gold
• Guanabenz
• Guanfacine
• Heparin
• Hyaluronidase, Recombinant; Immune Globulin
• Hydralazine
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Ibuprofen
• Hydrocortisone
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibritumomab Tiuxetan
• Ibuprofen
• Ibuprofen lysine
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Idelalisib
• Iloprost
• Imatinib
• Immune Globulin IV, IVIG, IGIV
• Indapamide
• Indomethacin
• Inotersen
• Interferon Alfa-2a
• Interferon Alfa-2b
• Interferon Alfa-2b; Ribavirin
• Iodipamide Meglumine
• Iohexol
• Ionic Contrast Media
• Iopamidol
• Iopromide
• Ioversol
• Ioxaglate Meglumine; Ioxaglate Sodium
• Irbesartan
• Isavuconazonium
• Isosulfan Blue
• Ivacaftor
• Ixabepilone
• Kanamycin
• Ketoconazole
• Ketoprofen
• Ketorolac
• Labetalol
• Lamivudine; Tenofovir Disoproxil Fumarate
• Lansoprazole; Naproxen
• Leflunomide
• Lepirudin
• Levobetaxolol
• Levobunolol
• Levomilnacipran
• Lisinopril
• Lithium
• Lomustine, CCNU
• Lopinavir; Ritonavir
• Losartan
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Macimorelin
• Magnesium Salicylate
• Magnesium Salts
• Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
• Mannitol
• Mecamylamine
• Mechlorethamine, Nitrogen Mustard
• Meclofenamate Sodium
• Mefenamic Acid
• Meloxicam
• Melphalan
• Mephobarbital
• Mesalamine, 5-ASA
• Methohexital
• Methotrexate
• Methoxsalen
• Methyldopa
• Methylprednisolone
• Methylsulfonylmethane, MSM
• Metoprolol
• Mifepristone
• Milnacipran
• Minoxidil
• Mitomycin
• Mitotane
• Mitoxantrone
• Modafinil
• Moexipril
• Mometasone
• Muromonab-CD3
• Nabumetone
• Nadolol
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nebivolol
• Nebivolol; Valsartan
• Nelarabine
• Neomycin
• Neostigmine
• Nitroprusside
• Non-Ionic Contrast Media
• Olmesartan
• Omacetaxine
• Ombitasvir; Paritaprevir; Ritonavir
• Oritavancin
• Oxaprozin
• Paclitaxel
• Paroxetine
• Pazopanib
• Pegaspargase
• Penbutolol
• Pentamidine
• Pentobarbital
• Pentosan
• Pentostatin
• Perindopril
• Perindopril; Amlodipine
• Pexidartinib
• Phenobarbital
• Phenoxybenzamine
• Phentermine; Topiramate
• Phentolamine
• Photosensitizing agents (topical)
• Physostigmine
• Pindolol
• Piroxicam
• Platelet Inhibitors
• Pneumococcal Vaccine, Polyvalent
• Polyethylene Glycol; Electrolytes
• Polyethylene Glycol; Electrolytes; Ascorbic Acid
• Polymyxin B
• Polymyxins
• Porfimer
• Posaconazole
• Potassium
• Pralatrexate
• Prasugrel
• Prazosin
• Prednisolone
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• Primidone
• Probenecid
• Procarbazine
• Propranolol
• Pyridostigmine
• Quinapril
• Quinolones
• Ramipril
• Reserpine
• Reteplase, r-PA
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• Rivaroxaban
• Rivastigmine
• Romidepsin
• Rucaparib
• Sacubitril; Valsartan
• Salicylates
• Salsalate
• Secobarbital
• Selective serotonin reuptake inhibitors
• Sertraline
• Simeprevir
• Sodium Hyaluronate, Hyaluronic Acid
• Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Sotalol
• Spironolactone
• Streptokinase
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• Streptozocin
• Sulfinpyrazone
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• Sulindac
• Tacrine
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• Telithromycin
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• Tenofovir, PMPA
• Terazosin
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• Thiazide diuretics
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• Thrombolytic Agents
• Ticagrelor
• Ticlopidine
• Timolol
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• tobacco
• Tobramycin
• Tolazamide
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• Urea
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• Vortioxetine
• Warfarin
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