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

Diclofenac is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. Voltaren is also indicated for the treatment of ankylosing spondylitis. The Cataflam brand of this medicine is also used to treat menstrual cramps.

Diclofenac powder (Cambia) is used to treat a migraine headache attack. Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).

Diclofenac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

Take diclofenac exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Use the lowest dose that is effective in treating your condition.

Different brands of diclofenac contain different amounts of diclofenac, and may have different uses. If you switch brands, your dose needs may change. Follow your doctor's instructions about how much medicine to take. Ask your pharmacist if you have any questions about the brand you receive at the pharmacy.

Swallow the tablet whole and do not crush, chew, or break it.

Take Zorvolex on an empty stomach, at least 1 hour before or 2 hours after a meal.

Dissolve the powder form of this medicine (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. Cambia works best if you take it on an empty stomach.

Call your doctor if your headache does not completely go away after taking Cambia.

If you use diclofenac long-term, you may need frequent medical tests.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Usual Adult Dose for Osteoarthritis:

Diclofenac free acid capsules: 35 mg orally 3 times a day
Diclofenac potassium immediate-release tablets: 50 mg orally 2 or 3 times a day
Diclofenac sodium enteric-coated tablets: 50 mg orally 2 or 3 times a day or 75 mg orally 2 times a day
Maximum dose: 150 mg daily

Diclofenac sodium extended-release tablets: 100 mg orally once a day

Use: For the relief of signs and symptoms of osteoarthritis.

Usual Adult Dose for Ankylosing Spondylitis:

Diclofenac sodium enteric-coated and delayed-release tablets: 25 mg orally 4 times a day. An additional 25 mg dose may be administered at bedtime, if necessary
Maximum dose: 125 mg per day

Use: For acute or long-term use in the relief of signs and symptoms of ankylosing spondylitis.

Usual Adult Dose for Dysmenorrhea:

Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day.

Comments: An initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief for some patients; initiate treatment upon appearance of the first symptoms and continue for a few days.

Use: For the relief of signs and symptoms of primary dysmenorrhea.

Usual Adult Dose for Rheumatoid Arthritis:

Diclofenac potassium immediate-release tablets: 50 mg orally 3 or 4 times a day
Diclofenac sodium enteric-coated and delayed-release tablets: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day
Maximum dose: 225 mg daily

Diclofenac sodium extended-release tablets: 100 mg orally once a day
Maximum dose: 100 mg orally 2 times a day; this would be for the rare patient in whom the benefits outweigh the clinical risks.

For the relief of signs and symptoms of rheumatoid arthritis

Usual Adult Dose for Migraine:

Diclofenac potassium for oral solution packets: 50 mg (1 packet) orally once

Comments: This drug is not indicated for the prophylactic therapy of migraine or for use in cluster headaches; the safety and efficacy of a second dose has not been established.

Use: For acute treatment of migraine with or without aura.

Usual Adult Dose for Pain:

Oral:
Diclofenac potassium liquid-filled capsules: 25 mg orally 4 times a day
Diclofenac free acid capsules: 18 mg or 35 mg orally 3 times a day
Diclofenac potassium immediate-release tablets: 50 mg orally 3 times a day; an initial dose of 100 mg orally followed by 50 mg oral doses may provide better relief in some patients.

Parenteral:
37.5 mg IV bolus over 15 seconds every 6 hours as needed for pain
Maximum Dose: 150 mg per day.

Comment: Patients should be well hydrated prior to IV administration of this drug in order to reduce the risk of adverse renal reactions.

Uses: For the management of mild to moderate acute pain (oral, IV) and moderate to severe pain alone or in combination with opioid analgesics (IV). Use: Treatment of panic disorder, with or without agoraphobia

Diclofenac can increase your risk of fatal heart attack or stroke, even if you don't have any risk factors. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

You should not use diclofenac if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Do not use Cambia to treat a cluster headache. Do not use Zipsor if you are allergic to beef or beef protein.

To make sure this medicine is safe for you, tell your doctor if you have:

• heart disease, high blood pressure;
• ulcers or bleeding in your stomach;
• asthma;
• liver or kidney disease; or
• if you smoke.

Diclofenac can affect ovulation and it may be harder to get pregnant while you are using this medicine.

If you are pregnant, you should not take diclofenac unless your doctor tells you to. Taking a NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Diclofenac is not approved for use by anyone younger than 18 years old.

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.

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

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).

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

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.

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

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

Avoid taking aspirin or other NSAIDs unless your doctor tells you to.

Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to diclofenac (such as aspirin, ibuprofen, ketoprofen, or naproxen).

Get emergency medical help if you have signs of an allergic reaction to diclofenac (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Stop using diclofenac and seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath.

Stop using this medicine and call your doctor at once if you have:

• the first sign of any skin rash, no matter how mild;
• flu-like symptoms;
• heart problems - swelling, rapid weight gain, feeling short of breath;
• kidney problems - little or no urinating, painful or difficult urination, swelling in your arms or legs, feeling tired or short of breath;
• liver problems - nausea, diarrhea, stomach pain (upper right side), tiredness, itching, dark urine, jaundice (yellowing of the skin or eyes); or
• signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Common diclofenac side effects may include:

• indigestion, gas, nausea, vomiting, stomach pain;
• diarrhea, constipation;
• headache, dizziness, drowsiness;
• abnormal lab tests;
• itching, sweating;
• stuffy nose;
• increased blood pressure; or
• swelling or pain in your arms or legs.

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.

Ask your doctor before using diclofenac if you take an antidepressant. Taking certain antidepressants with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all your other medicines, especially:

• heart or blood pressure medication, including a diuretic or "water pill";
• other forms of diclofenac (Arthrotec, Flector, Pennsaid, Solaraze, Voltaren Gel);
• a blood thinner - warfarin, Coumadin, Jantoven; or
• other NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with diclofenac, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

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.

The diclofenac capsules and tablets typically take about 20 to 30 minutes to work.

It’s best to take the lowest dose of diclofenac for the shortest possible time to lower your chances of developing serious side effects. But some people with chronic conditions, such as rheumatoid arthritis, may need to take this medicine for an extended period of time.

Your doctor may recommend another medicine to protect your stomach if you need to take diclofenac long-term.

Your dosage will depend on your medical condition, the brand of diclofenac you use, the formulation you take, and other factors.

Follow your doctor’s instructions carefully and be sure to check your prescription to make sure you receive the correct brand of this medicine before you take it.

Diclofenac may be used to treat other medical conditions that cause pain or inflammation.