Diclofenac (Voltaren) is a medicine used in the treatment of pain and inflammation. It alleviates the symptoms of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. The generic drug, Cataflam is also used in the treatment of menstrual cramps. Its use for a long period and at high doses is not recommended especially in patients with heart problems. Studies show that the use of diclofenac may increase the risk of fatal heart attack or paralysis. The most common side effects of Diclofenac are headache, dizziness, indigestion, and stomach disorders. You should use the medicine as recommended by your doctor to reduce the side effects.
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What is Diclofenac (Voltaren)?
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. Its active ingredient, diclofenac sodium, is found in different amounts in Diclofenac tablet. Diclofenac which is sold in tablet forms of 25 mg, 50 mg, 75 mg, and 100 mg can also be found in pharmacies as the generic drugs Cataflam and Voltaren. (1)
What is Diclofenac used for?
What is the function of Diclofenac?
NSAIDs, including ibuprofen and aspirin, alleviate inflammation and pain. These drugs are mostly used in the treatment of inflammation-induced pain, soft tissue injuries such as sprains, and muscle-joint pain.
What can I use diclofenac for?
- Osteoarthritis: Calcification
- Rheumatoid arthritis: Joint pain and malformation
- Ankylosing spondylitis: Painful progressive rheumatism presenting with stiffness in the back, neck and thoracic joints
- Acute gouty arthritis: Joint inflammation due to acute gout
- Joint and muscle pain,
- Postoperative pain,
- Menstrual pain,
- Pain in the back and lower back (2)
How does (Diclofenac) Voltaren work?
The active ingredient, Diclofenac, inhibits an enzyme called cyclooxygenase (COX) in the body. During injury or arthritis, COXs in the body start to produce prostaglandins that cause pain, swelling, and inflammation. Diclofenac inhibits this production, alleviating inflammation and pain. (3)
How is Diclofenac (Voltaren) used?
- Take Voltaren tablets on a full stomach with a glass of water or milk to avoid stomach discomfort. Do not crush, break, or chew the tablets.
- If you need to use Voltaren regularly every day, take it at about the same time.
- Use the medicine as recommended by your doctor. Do not change the dose without consulting the doctor.
- Your doctor may adjust the dose of your medicine depending on your response to treatment. Inform your doctor about how you feel during a treatment.
- If you forget to take a dose, do not take a double dose to compensate the missed dose. Either take the dose immediately, or if it’s almost time for your next dose, take the next dose skipping the missed one.
- If you think the effect of your medicine is too strong or too weak, inform your doctor.
- If your complaints are more intense at night or in the morning, try to take your medicine in the evening.
- Do not exceed the dose recommended by your doctor. It is recommended that you use the medicine at the lowest dose for the shortest period of time.
- If you take any prescription or over-the-counter medicines or supplements, be sure to inform your doctor.
- Voltaren tablet is not used in children and adolescents under the age of 18.
Doses of Diclofenac and Dose Adjustment
- Treatment of osteoarthritis (Calcification): The recommended dose is 100-150 mg daily. The medicine can be taken at 50 mg doses twice a day or three times a day, or at 75 mg doses twice a day.
- Treatment of rheumatoid arthritis: The recommended dose is 150-200 mg daily. It can be taken at 50 mg doses three or four times a day, or at 75 mg doses twice a day.
- Ankylosing spondylitis treatment: The recommended dose is 100-125 mg, taken at 25 mg doses four times a day. If necessary, an additional 25 mg dose can be taken at bedtime.
How long can you take diclofenac?
In Diclofenac treatment, the lowest dose for the shortest period, which may achieve therapeutic objectives, is recommended. The purpose is to ensure that a patient is minimally affected by the side effects of the medicine. Depending on a patient’s response to treatment, a doctor can adjust the dose and intensity of use.
If you take more than recommended dose, contact your doctor, pharmacist, or apply to the closest emergency immediately. You may need medical care. Do not forget to take the box of the medicine with you and do not drive.
How to stop taking Diclofenac?
Diclofenac treatment must be ended under the control of a doctor. Do not stop taking your medicine without consulting your doctor.
Efficacy and safety for diclofenac (Voltaren)
Drug interactions of Diclofenac
Some medications can adversely affect Diclofenac treatment. Be sure to inform your doctor if you take one of the following medicines:
- Other nonsteroidal anti-inflammatory drugs: Aspirin, ibuprofen etc. (4)
- Some antibiotics: Ciprofloxacin, levofloxacin, moxifloxacin, nalidixic acid, norfloxacin or ofloxacin
- Anticoagulants: Warfarin etc.
- Digoxin (for heart diseases)
- Medicines for Hypertension
- Cholesterol-lowering drugs: Colestipol and cholestyramine.
- Phenytoin (used for convulsion treatment)
- Lithium (a psychiatric drug)
- Selective serotonin reuptake inhibitors – SSRIs: Antidepressants such as Citalopram, sertraline etc.
- Steroid drugs: Hydrocortisone, prednisolone etc.
- Diabetes medicines (excluding insulin)
- Methotrexate (A medicine used to treat various inflammatory diseases and some types of cancer)
- Mifepristone (A medicine used to terminate pregnancy)
- Medicines suppressing the immune system (especially used in organ transplant patients): cyclosporine and tacrolimus
- Diuretics: Furosemide, bumetanide, etc.
- Zidovudine (a medicine used in the treatment of HIV)
- Cardiac glycosides (a group of drugs used in the treatment of heart diseases).
- Trimethoprim (a medicine used in the treatment and prevention of urinary tract infections)
- Voriconazole (a medicine used in fungal infections).
In addition, concurrent use of supplements and herbal medicines with Diclofenac may not be safe. These drugs are not usually tested for their effects on other drugs.
Duration of Diclofenac treatment
Diclofenac takes effect after a single dose, and its effect gradually increase as used regularly. The general condition of a patient is checked by a doctor, and if necessary, treatment is discontinued.
Forms and types of Voltaren
- Voltaren Emulgel: 10mg / g cream
- Voltaren Osteo Gel 12 hourly: 100 g and 150 g tubes.
Tablets and liquid capsules
- Voltaren 25 mg and 50 mg enteric-coated tablet,/ Voltaren SR 75 mg film-coated tablet / Voltaren Retard 100 mg tablet
- Voltaren Suppository (100 mg suppository)
- Cataflam 50 mg sugar-coated tablet
Forms of Diclofenac
Medicines containing the active ingredient, diclofenac, can be found in tablet, capsule, liquid-filled capsule, enteric-coated tablet, extended-release tablet, cream, gel, effervescent tablet, solution for injection, suppository, extended-release patch and powder forms.
Who should not use Diclofenac?
- Children under 18
- Those allergic to diclofenac or any component of Diclofenac
- Those allergic to other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Patients with bleeding or perforation in the gastrointestinal tract or with a history of these problems
- Those who have gastric ulcer, intestinal ulcer, or those with a history of these diseases
- Those who underwent coronary artery surgery such as cardiovascular surgery or bypass
- Women who are in the last trimester of pregnancy.
- Those with severe heart failure or cardiovascular obstruction
- Those with severe liver or renal disease,
Diseases which Diclofenac is inconvenient
Diclofenac should be used with caution in the following situation:
- Risk Group for Heart diseases: The medicine should be prescribed after evaluating the patients at high risk for heart diseases, such as those with hypertension, high cholesterol, diabetes, or smokers.
- Asthma or hay fever (seasonal allergy)
- Gastrointestinal problems: The medicine should be used under the supervision of a doctor in patients with a history of gastrointestinal problems, such as gastric ulcer, gastric bleeding or black stool, or previously with gastric disorders after using NSAIDs.
- Ulcerative colitis or Crohn’s disease
- Liver or renal problems
- Dehydration due to situations such as disease or diarrhea, or before a surgery
- Swelling in the feet
- Bleeding disorder or different blood-related conditions
If you experience any of above-mentioned conditions, consult your doctor immediately.
Diclofenac during breastfeeding and pregnancy
Use of Voltaren during pregnancy
Use of Voltaren is not recommended during pregnancy, unless considered absolutely necessary by a doctor. As with other NSAIDs, Voltaren should not be used especially in the last trimester of pregnancy. Do not use Voltaren if you plan to become pregnant. The medicine may make it difficult to get pregnant.
Use of Voltaren during breastfeeding
The components of the medicine may pass into milk. Do not take Voltaren while breastfeeding.
Side effects of Diclofenac (Voltaren)
Common Side Effects
- Headache, feeling of drowsiness, or dizziness
- Indigestion, diarrhea, abdominal pain, or wind
- Heartburn, nausea, vomiting
- Loss of appetite
- Abnormal liver function test results
- Skin rash
Uncommon Side Effects
- Heart attack or myocardial infarction
- Heart failure
- Chest pain
Rare side effects
- Bleeding or bruises of unknown origin
- High fever, recurrent infections, constant sore throat
- Allergic reactions symptoms: difficulty in breathing and swallowing, skin rash, itching, hives, dizziness
- Pneumonitis (a type of lung inflammation) symptoms: wheeze and cough, sudden onset dyspnea, tightness in chest
- Stroke symptoms: Sudden and severe headache, nausea, drowsiness, numbness, difficulty in speaking, fatigue, paralysis of lips and face
- Meningitis symptoms: stiff neck, fever, nausea, vomiting, headache
- Gastrointestinal bleeding symptoms: vomiting blood and /or black or bloody stool
- Gastrointestinal ulcer symptoms: stomach pain, nausea
- Jaundice symptoms: Yellowing of the skin or eyes
- Hepatitis or liver failure symptoms: nausea, loss of appetite, dark urine
- Liver disorder,
- Hives (urticaria),
Very rare side effects
- Swelling of the face and throat
- Symptoms of colitis
- Reddening, bruising, scaling, peeling, or blisters in the skin, eyes and mouth
- Extreme skin sensitivity to the sun (Photosensitivity)
- Frequent urination or low urine output, or excessive protein in the urine
- Losing the perception of place and time
- Depression, anxiety or bad mood
- Insomnia or nightmares
- Tingling or numbness in the hands or feet
- Memory problems,
- Hearing impairment or tinnitus
- Loss of taste or impaired vision
Be sure to inform your doctor about any side effect you experience.
Does diclofenac cause heart attacks?
In a study conducted in Aarhus University Hospital, it was found that the use of diclofenac may lead to an increased risk of heart disease. Starting from 1996, over 6.3 million participants have used diclofenac, other NSAIDs, or paracetamol for 10 years. The study results showed an increase in health problems such as arrhythmia or palpitation, paralysis, heart failure and heart attack in patients taking diclofenac. (5)
Voltaren (diclofenac) prescription
For more information about Voltaren tablet (diclofenac), you can access the prescription via this link.