PMS-Diclofenac

Brand Names: PMS-Diclofenac

Common Name: diclofenac

What is this drug used for?

Diclofenac belongs to the class of medications known as non-steroidal anti-inflammatories (NSAIDs). It works by reducing pain, swelling, and inflammation. The tablet and suppository are used to relieve pain for people with rheumatoid arthritis, osteoarthritis, and degenerative joint diseases of the hip. The eye drop is used to reduce eye inflammation before and after eye surgery (e.g., cataract surgery) and in other cases of eye inflammation where infection is not present.

Your doctor may choose to use this medication for conditions other than the ones listed here. If you're unsure why you are taking this medication, contact your doctor.

Is there any reason not to take this drug?

Diclofenac should not be taken by anyone who:

• currently has or recently had inflammatory diseases of the stomach and intestines, such as stomach or intestinal ulcer or ulcerative colitis
• has significant liver impairment or liver disease
• has severely impaired or deteriorating kidney function
• is currently taking other NSAIDs
• is or may be allergic to diclofenac or any of the ingredients of the medication
• has had an allergic reaction to ASA or other anti-inflammatory medications.

Suppositories should not be used by anyone who:

• has any inflammatory lesions of the rectum or anus
• has recently had rectal or anal bleeding

What about possible side effects?

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if the following side effects continue or become bothersome. A common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is stomach upset. This can be minimized by taking the medication immediately after a meal, or with food or milk.

More common

• abdominal or stomach cramps, pain, or discomfort (mild to moderate)
• diarrhea
• dizziness, drowsiness, or lightheadedness
• headache (mild to moderate)
• heartburn, indigestion, nausea, or vomiting

  Less common or rare

• bitter taste or other change in taste sensation
• bloated feeling, gas, or constipation
• decreased appetite or loss of appetite
• fast or pounding heartbeat
• flushing or hot flashes
• general feeling of discomfort or illness
• increased sensitivity of eyes to light
• increased sweating
• irritation, dryness, or soreness of mouth
• nervousness, anxiety, irritability, trembling, or twitching
• rectal irritation (with suppositories)
• trouble sleeping
• unexplained weight loss
• unusual tiredness or weakness without any other symptoms

Contact your doctor as soon as possible if any of the following side effects occur:

More common

• bleeding from rectum (with suppositories)
• skin rash

  Less common or rare

bladder pain bleeding from cuts or scratches that lasts longer than usual bleeding or crusting sores on lips bloody or cloudy urine or any problem with urination, such as difficult, burning, or painful urination change in urine colour or odour frequent urge to urinate sudden, large increase or decrease in the amount of urine or loss of bladder control blurred vision or any change in vision burning feeling in throat, chest, or stomach confusion, forgetfulness, mental depression, or other mood or mental changes cough or hoarseness decreased hearing, any other change in hearing, or ringing or buzzing in ears difficulty swallowing eye pain, irritation, dryness, redness, or swelling hallucinations headache (severe), throbbing, or with stiff neck or back

hives, itching of skin, or any other skin problem, such as blisters, redness or other colour change, tenderness, burning, peeling, loosening or splitting of fingernails muscle cramps, pain, or weakness numbness, tingling, pain, or weakness in hands or feet pain in lower back or side (severe) swelling or tenderness in upper abdominal or stomach area swelling of face, feet, or lower legs swelling of lips or tongue swollen or painful glands (especially in the neck or throat area) thirst (continuing) difficulty speaking unexplained runny nose or sneezing unexplained, unexpected, or unusually heavy vaginal bleeding unusual tiredness or weakness weight gain (rapid) yellow eyes or skin

Stop taking this medication and contact your doctor immediately if any of the following side effects occur:

Rare

• abdominal or stomach pain, cramping, or burning (severe)
• bloody or black, tarry stools
• chest pain
• convulsions (seizures)
• fever with or without chills
• nausea, heartburn, or indigestion (severe and continuing)
• pinpoint-sized red spots on skin
• sores, ulcers, or white spots on lips or in mouth
• spitting up of blood
• unexplained nosebleeds
• unusual bleeding or bruising
• vomiting of blood or material that looks like coffee grounds

Stop taking this medication and get emergency help immediately if any of the following side effects occur:

Rare

• fainting
• fast or irregular breathing
• fast, irregular heartbeat or pulse
• hive-like swellings (large) on face, eyelids, mouth, lips, or tongue
• puffiness or swelling of the eyelids or around the eyes
• shortness of breath, troubled breathing, wheezing, or tightness in chest

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

The following medications may affect the way that diclofenac works or increase the risk of side effects:

• ASA
• alcohol
• angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril)
• beta-adrenergic blockers (e.g., metoprolol, atenolol)
• cholestyramine
• corticosteroids (e.g., prednisone)
• diuretics (water pills; e.g., spironolactone)
• heparin
• other NSAIDs (e.g., naproxen, indomethacin)
• potassium supplements
• sucralfate
• warfarin

Diclofenac may affect the way that the following medications work:

• cyclosporine
• digoxin
• heparin
• lithium
• methotrexate
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, decongestants, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Fluid and electrolyte balance: Fluid retention and edema have been reported with use of this medication. Diclofenac should be used with caution by anyone who:

• has certain heart conditions (e.g., congestive heart failure)
• has high blood pressure
• has kidney disease or reduced kidney function
• is recovering from a surgical operation under general anesthesia
• has any other condition that might lead to fluid retention

There is a risk of high blood potassium with NSAID treatment. Those most at risk include seniors, those with conditions such as diabetes or kidney failure, and those taking beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors, or some diuretics (water pills).

Gastrointestinal: Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with diclofenac. These complications can occur at any time, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding are increased for people taking higher doses of NSAIDs for longer periods of time.

Diclofenac should be taken under close medical supervision by people prone to irritation of the stomach and intestines, particularly those who have had a stomach ulcer, bloody stools, or diverticulosis or other inflammatory disease of the stomach or intestines (such as ulcerative colitis or Crohn's disease). In these cases, your doctor must weigh the benefits of treatment against the possible risks.

Stop taking the medication and contact your doctor immediately if you experience symptoms or signs suggestive of stomach ulcers or bleeding in the stomach (black, tarry stools). These reactions can occur at any time during treatment without warning.

Kidney function: Long-term use of diclofenac may lead to a higher risk of reduced kidney function. This is most common for people who already have kidney disease, liver disease, or heart failure; for people who are take diuretics (water pills); and for seniors.

Occupational hazards: Some people have reported headache, dizziness, lightheadedness, and confusion while taking this medication. Avoid operating motor vehicles and doing other potentially hazardous activities until you have determined the effect this medication has on you.

Pregnancy: This medication is not recommended for use during pregnancy as its safety has not been established.

Breast-feeding: This medication should not be used by nursing mothers.

Children: Diclofenac is not recommended for children under 16 years of age. The safety, effectiveness, and dosage of this medication for this age group have not been established.

Seniors: Seniors appear to have a higher risk of side effects with this medication. The lowest effective dosage should be used under close medical supervision.

Special Instructions:

Tablets: The usual adult dosage ranges from 75 mg to 150 mg daily. The immediate release tablets are taken in three equally divided doses with food, while the long-acting (sustained release, or SR) tablets are taken in 1 or 2 daily doses with food or milk. The maximum recommended daily dose of diclofenac is 150 mg.

Suppositories: The suppositories are usually used as a substitute for the last daily dose in a 50 mg or 100 mg strength, to a maximum total daily dose of 150 mg of diclofenac.

Eye drops: For inflammation, it is recommended that one drop be put into the eye 4 to 5 times daily. For surgery, the eye drops are used as follows:

• in the 3 hours before the surgery, one drop is put into the eye up to a maximum of 5 times
• in the first 45 minutes after surgery, one drop is put into the eye every 15 minutes
• subsequently, one drop may be put into the eye 3 to 5 times daily as needed

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

This medication is available under multiple brand names and in several different forms. Any specific brand name of this medication may not be available in all of the forms listed here. The forms available for the specific brand you have searched are listed under "What form(s) does this medication come in?"

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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