Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

Diclofenac topical (for the skin) is used to treat joint pain caused by osteoarthritis. This medicine is for use on the hands, wrists, elbows, knees, ankles, or feet. Diclofenac topical may not be effective in treating arthritis pain elsewhere in the body.

Pennsaid is for use only on the knees.

Solaraze is used to treat warty overgrowths of skin (actinic keratoses) on sun-exposed areas of the body.

Diclofenac topical may also be used for purposes not listed in this medication guide.

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

You should not use this medicine if you are allergic to diclofenac (Voltaren, Cataflam, Flector, and others), or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

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

Tell your doctor if you have ever had:

• heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
• a heart attack, stroke, or blood clot;
• stomach ulcers, bleeding in your stomach or intestines;
• asthma;
• liver or kidney disease; or
• fluid retention.

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 topical unless your doctor tells you to. Taking an 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.

Use Dst Plus Pak (Topical) exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Get emergency medical help if you have signs of an allergic reaction (hives, sneezing, runny or stuffy nose, wheezing or trouble 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.

Stop using diclofenac and seek emergency medical attention 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.

Also call your doctor at once if you have:

• a skin rash, no matter how mild;
• swelling, rapid weight gain;
• severe headache, blurred vision, pounding in your neck or ears;
• little or no urination;
• liver problems--nausea, diarrhea, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• low red blood cells (anemia)--pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet; or
• signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Common side effects may include:

• heartburn, gas, stomach pain, nausea, vomiting;
• diarrhea, constipation;
• headache, dizziness, drowsiness;
• stuffy nose;
• itching, increased sweating;
• increased blood pressure; or
• skin redness, itching, dryness, scaling, or peeling where the medicine was applied.

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 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).

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

Avoid exposing treated skin to heat, sunlight, or tanning beds. Heat can increase the amount of diclofenac you absorb through your skin.

Avoid getting this medicine in your eyes. If contact does occur, rinse with water. Call your doctor if you have eye irritation that lasts longer than 1 hour.

Do not use cosmetics, sunscreen, lotions, insect repellant, or other medicated skin products on the same area you treat with diclofenac topical.