Diclofenac

Arthritis and Joint Pain

Diclofenac is commonly prescribed to manage symptoms of chronic inflammatory conditions, including:

• Osteoarthritis: To reduce joint pain and stiffness.
• Rheumatoid arthritis: To manage inflammation and pain in the joints.
• Ankylosing spondylitis: To treat pain and inflammation affecting the spine.

Topical versions of the medication, such as gels or liquids, are used to treat osteoarthritis pain in specific joints that are close to the skin's surface, such as the hands, knees, elbows, and feet.

Other Pain Relief

Oral forms of diclofenac are also used for short-term relief of other types of pain, such as:

• Menstrual cramps.
• Mild to moderate acute pain from injuries or other conditions.
• Migraine headaches (specifically using certain oral solution forms).

Skin Conditions

Certain topical formulations of diclofenac are used to treat actinic keratosis. This is a skin condition characterized by rough, scaly patches caused by years of sun exposure, which may become cancerous if left untreated.

Combination Use

In some cases, diclofenac is used in combination with other medications, such as misoprostol. This combination is intended for people who need an NSAID for arthritis but are at high risk of developing stomach ulcers or other gastrointestinal complications.

Diclofenac belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). It works by inhibiting the action of specific enzymes called cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These enzymes are responsible for the production of prostaglandins, which are hormone-like chemicals the body releases in response to injury or certain medical conditions.

Prostaglandins play a major role in how the body experiences several symptoms:

• Pain: They sensitize nerve endings, making the body more responsive to pain signals.
• Inflammation: They cause blood vessels to widen, leading to the swelling, redness, and heat associated with inflammation.
• Fever: They can affect the area of the brain that regulates body temperature.

By reducing the levels of these chemicals, diclofenac helps decrease swelling, tenderness, and pain. Whether it is taken as a pill or applied to the skin as a gel or patch, the medication targets these chemical pathways to manage symptoms of conditions such as arthritis, migraines, and acute physical injuries.

Common Side Effects

Common side effects often depend on how the medication is used. These symptoms may improve as your body adjusts to the treatment.

• Oral forms: Diarrhea, constipation, gas, bloating, headache, dizziness, and ringing in the ears.
• Topical forms: Redness, itching, dryness, scaling, or general irritation at the application site.

Serious Side Effects

Contact a healthcare provider immediately if you experience any of the following serious symptoms:

• Allergic reactions: Hives, skin rash, or swelling of the face, throat, or tongue.
• Digestive problems: Severe stomach pain, black or tarry stools, or vomiting blood or material that looks like coffee grounds.
• Liver or kidney issues: Yellowing of the skin or eyes, dark urine, unexplained weight gain, or swelling in the legs and feet.
• Cardiovascular symptoms: Chest pain, shortness of breath, or sudden weakness on one side of the body.
• Other concerns: Blisters, fever, or painful urination.

Cardiovascular Risks

Nonsteroidal anti-inflammatory drugs (NSAIDs), including diclofenac, may increase the risk of serious cardiovascular events, such as heart attack and stroke. This risk can occur early in treatment and may increase with longer use. Diclofenac is contraindicated for the treatment of pain before or after heart bypass surgery.

Gastrointestinal Risks

Diclofenac can cause serious gastrointestinal issues, including inflammation, bleeding, and holes (perforation) in the stomach or intestines. These conditions can be fatal and may occur without warning. Older adults and those with a history of stomach ulcers or bleeding are at a higher risk.

Allergic Reactions

Serious allergic reactions, including life-threatening skin reactions, can occur. Diclofenac is typically avoided by individuals who have experienced asthma, hives, or other allergic reactions after taking aspirin or other NSAIDs.

Liver and Kidney Health

Treatment with diclofenac can lead to changes in liver function tests. In rare instances, severe liver damage has been reported. Long-term use may also affect kidney function, particularly in those with existing kidney disease, heart failure, or liver problems.

Pregnancy and Fertility

Diclofenac is generally avoided during the later stages of pregnancy, specifically from 30 weeks onward, due to risks to the fetal heart. Use after 20 weeks may also lead to kidney issues in the fetus. Additionally, NSAIDs may temporarily reduce fertility in women.

Pregnancy

Diclofenac is typically avoided during pregnancy unless specifically recommended by a healthcare provider. Taking this medication at 20 weeks of pregnancy or later may cause rare but serious kidney problems in the unborn baby, which can lead to low levels of amniotic fluid and potential complications.

It is especially important to avoid diclofenac starting at 30 weeks of pregnancy. Use during the third trimester can cause a vital blood vessel in the baby's heart to close prematurely, which may lead to heart or lung problems after birth. Additionally, some formulations of diclofenac that are combined with other medications, such as misoprostol, are strictly contraindicated during pregnancy because they can cause miscarriage or birth defects.

For those trying to conceive, nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac may temporarily interfere with ovulation, potentially affecting fertility.

Breastfeeding

Diclofenac passes into breast milk in small amounts. While it is generally considered compatible with breastfeeding, the potential risks and benefits should be discussed with a healthcare professional to determine the safest course of action.

Oral Formulations

Diclofenac is available in several oral formats designed to release the medication in different ways:

• Tablets: These include immediate-release, delayed-release (enteric-coated), and extended-release versions.
• Capsules: Available as liquid-filled or hard-shell capsules.
• Oral Solution: A powder that is mixed with water before drinking.

Topical Formulations

For localized pain, diclofenac can be applied directly to the skin in the following forms:

• Gels and Solutions: Often used for joint pain in the hands, wrists, elbows, knees, or ankles.
• Transdermal Patches: Applied to the skin to provide a continuous release of medication to a specific area.

Other Formulations

Diclofenac is also available in specialized forms for specific conditions:

• Ophthalmic Solution: Eye drops used to treat inflammation or pain associated with eye surgery.
• Injectable Solution: Administered by healthcare providers through an injection into a muscle or an infusion into a vein.

FDA Approval and Indications

Diclofenac is approved by the U.S. Food and Drug Administration (FDA) for the management of pain and inflammation associated with several conditions. These include:

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Acute pain and migraine (specific formulations)
• Actinic keratosis (topical formulation)

Boxed Warnings

The FDA requires a boxed warning for all prescription nonsteroidal anti-inflammatory drugs (NSAIDs), including diclofenac. This warning highlights two major risks:

• Cardiovascular Risk: NSAIDs may increase the risk of serious cardiovascular thrombotic events, such as heart attack and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
• Gastrointestinal Risk: NSAIDs increase the risk of serious gastrointestinal adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms.

Regulatory Status

Diclofenac is available in multiple dosage forms, including oral tablets, capsules, topical gels, solutions, and patches. While most forms require a prescription, certain topical formulations have been approved for over-the-counter (OTC) use for the temporary relief of arthritis pain.

Gastrointestinal Risks

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Using alcohol while taking this medication can increase the risk of serious side effects, particularly in the stomach and intestines. This combination may lead to:

• Stomach ulcers
• Bleeding in the digestive tract
• Perforation (holes) in the stomach or intestines

The risk of these complications is generally higher for people who consume three or more alcoholic drinks daily while using NSAIDs. It is important to talk to a healthcare provider about your alcohol intake before using diclofenac, especially if you have a history of stomach issues.

Seek immediate medical care if you notice signs of internal bleeding, such as black or tarry stools, or vomit that contains blood or looks like coffee grounds.