Diclofenac: Uses, How It Works, Medicines
Diclofenac is an NSAID painkiller used to relieve pain and swelling in arthritis, back pain, gout attacks, injuries and period pain. It is usually a prescription-type medicine given at the lowest dose for the shortest time. Diclofenac can raise the risk of heart attack, stroke, stomach bleeding and kidney problems, and is not for people with heart disease or a past stroke. It is sold as tablets, injections and gels.
Also known as: Diclofenac sodium, Diclofenac potassium, Diclofenac tablet, Diclofenac 50 mg, Diclofenac 75 mg, Diclofenac IP, Diclofenac sodium gastro-resistant, Diclofinac, Diclophenac, Voveran, Voltaren
Pharmacist review in progress. This page is based on the sources listed below and is being checked by our registered pharmacist.
How does Diclofenac work?
Diclofenac blocks enzymes called COX-1 and COX-2, which lowers prostaglandins, the chemical messengers that cause pain, swelling and heat. The same effect in the stomach lining, kidneys and blood vessels explains its stomach, kidney and heart risks.
How to take Diclofenac
Follow the label or your doctor's advice. Diclofenac is usually taken at the lowest dose for the shortest time needed, and gastro-resistant tablets are swallowed whole. Doses for children, older people and people with kidney or liver problems should be decided by a doctor.
Side effects of Diclofenac
Stomach upset is the most common problem. Serious effects are less common but include stomach bleeding, heart attack, stroke, kidney or liver problems and severe skin reactions.
Uncommon or mild
- Stomach pain, heartburn or indigestion
- Feeling sick (nausea) or vomiting
- Diarrhoea or constipation
- Headache or dizziness
- Mild skin rash
- Raised liver test results
Rare but serious: get medical help
- Black or tarry stools, or vomiting blood, which can be signs of bleeding in the stomach or gut
- Chest pain, shortness of breath, weakness on one side or slurred speech, which can be signs of a heart attack or stroke. Get emergency help
- Signs of a severe allergic reaction: swelling of the face, lips or throat, difficulty breathing or a sudden widespread rash
- Red skin with blisters or peeling. Stop the medicine and get medical help immediately
- Swelling of the ankles, passing much less urine or sudden weight gain
- Yellowing of the skin or eyes, dark urine or severe tiredness
Who should be careful
Diclofenac carries a higher heart and blood-vessel risk than some other NSAIDs, so many people need to check with a doctor first.
When the label says not to use it
- Allergy to diclofenac, aspirin or other NSAIDs, including asthma, hives or swelling after taking them
- Active stomach or gut ulcer or bleeding, or a history of repeated ulcers or bleeding
- Heart failure, heart disease from blocked arteries, a past stroke or blocked leg arteries
- Severe kidney or liver failure
- The last 3 months of pregnancy
- Heart disease, heart failure, a past heart attack or stroke, or circulation problems in the legs: diclofenac is not for people with these conditions
- High blood pressure, high cholesterol, diabetes or smoking, which raise heart risk
- A past stomach or gut ulcer or bleeding, ulcerative colitis or Crohn's disease
- Kidney disease, liver disease, or being dehydrated
- Asthma, nasal polyps, or a past reaction to aspirin or another painkiller
- Pregnancy or breastfeeding: ask a doctor first; it is not for the last 3 months of pregnancy, and it may make it harder to become pregnant
- Older adults, who are more likely to have serious stomach and kidney effects
- Taking blood thinners, steroids, water tablets or other painkillers, or having surgery soon
Medicines and things that interact with Diclofenac
Many medicines change the risks of diclofenac. Tell your doctor or pharmacist about everything you take.
- Other NSAID painkillers, including aspirin and ibuprofen: more stomach, kidney and bleeding risk
- Blood thinners such as warfarin, and antiplatelet medicines: higher bleeding risk
- Steroid tablets and SSRI-type antidepressants: higher risk of stomach bleeding
- Water tablets (diuretics), ACE inhibitors and ARBs: can reduce their effect and strain the kidneys
- Ciclosporin and tacrolimus: can increase kidney harm
- Methotrexate and lithium: levels can rise
- Alcohol: raises the risk of stomach irritation
Effects on lab tests
- Liver and kidney tests and blood counts may be checked if diclofenac is used for a long time
Regulatory status in India
Approved for sale in India as tablets, injections and gels. Single-ingredient diclofenac is not on the CDSCO list of banned medicines, but some fixed-dose combinations containing diclofenac have been banned. Check the ingredient list and the schedule printed on the pack.
Type of medicine
Diclofenac belongs to this type of medicine.
Medicines that contain Diclofenac
These medicines sold in India contain Diclofenac. They are listed A to Z, not ranked.
- Voveran 50 · 50 mg gastro-resistant (enteric-coated) tablet
What is Diclofenac used for?
Medicines that contain Diclofenac are used for these conditions.
Other medicines of the same type
These active ingredients are of the same type as Diclofenac.
Common questions
What is diclofenac used for?
Diclofenac is used to relieve pain and swelling in conditions such as osteoarthritis, rheumatoid arthritis, back pain, gout attacks, injuries and period pain. It eases symptoms but does not treat the cause. A doctor decides when and how long to use it.
Is diclofenac bad for the heart?
It can raise the risk of heart attack and stroke, especially at higher doses or with long use. European regulators say it should not be used in people with heart failure, heart disease, a past stroke or blocked leg arteries, and should be used at the lowest dose for the shortest time.
Should diclofenac be taken with food?
Labels differ by form. Gastro-resistant tablets are usually swallowed whole, often before meals. If it upsets your stomach, ask your doctor or pharmacist about taking it with food. Stop and get help if you notice black stools or vomit blood.
Can I take diclofenac with other painkillers?
Not without a doctor's advice. Taking it with another NSAID such as ibuprofen or aspirin raises the risk of stomach bleeding and kidney harm without helping more. Paracetamol is a different type of painkiller; ask a pharmacist before combining.
Who should avoid diclofenac?
People with an active stomach ulcer or past bleeding, heart failure, heart disease, a past stroke, severe kidney or liver failure, or asthma or an allergic reaction after aspirin or other painkillers should avoid it. It is also not for the last 3 months of pregnancy.
Is diclofenac gel safer than tablets?
Gels put much less diclofenac into the blood than tablets, so general side effects are less likely, but skin reactions can occur. Gels are used on the skin over a painful area. Which form suits you is a decision for your doctor or pharmacist.
Sources
- Voltaren 25 mg and 50 mg gastro-resistant tablets: Summary of Product Characteristics. Malta Medicines Authority
- Diclofenac sodium delayed-release tablets: prescribing information (boxed warning on cardiovascular and gastrointestinal risk). DailyMed, US National Library of Medicine
- Diclofenac-containing medicines: referral. European Medicines Agency (EMA)
- Diclofenac. NHS (UK)
- Side effects of diclofenac. NHS (UK)
- Taking diclofenac with other medicines and herbal supplements. NHS (UK)
- Diclofenac. StatPearls, National Center for Biotechnology Information (NCBI), US National Library of Medicine
- ATC/DDD Index: M01AB05 diclofenac. WHO Collaborating Centre for Drug Statistics Methodology
- List of drugs prohibited for manufacture and sale through gazette notifications under section 26A of the Drugs & Cosmetics Act 1940. Central Drugs Standard Control Organisation (CDSCO)