Diclofenac

About Diclofenac

Like other NSAIDs, diclofenac blocks the COX-1 and COX-2 enzymes that make prostaglandins, signals behind pain and inflammation. Delayed-release tablets (diclofenac sodium) are labeled for osteoarthritis, rheumatoid arthritis and ankylosing spondylitis; extended-release tablets for osteoarthritis and rheumatoid arthritis at 100 mg once a day; and potassium tablets for menstrual cramps, mild to moderate pain, osteoarthritis and rheumatoid arthritis, typically 50 mg three times a day for pain. Zipsor, a 25 mg capsule taken four times a day, is labeled for mild to moderate acute pain from age 12, and Cambia, a 50 mg packet of powder mixed in water, for a migraine attack in adults; it does not prevent migraine. The labels say oral forms are not necessarily bioequivalent, even at the same milligram strength, and are not interchangeable, and the tablets have not been shown safe and effective in children.

The prescription forms carry the NSAID boxed warning about serious heart attacks and strokes, which can be fatal and may begin early in treatment, and about bleeding, ulcers and perforation of the stomach or intestines, which can be fatal and occur without warning. Diclofenac must not be used in the setting of coronary artery bypass graft (CABG) surgery, by anyone allergic to it, or after asthma, hives or an allergic-type reaction to aspirin or another NSAID; Zipsor, which contains gelatin, is not used with a bovine protein allergy, and patches are not applied to broken or damaged skin. The tablet labels single out liver injury, advising liver tests within 4 to 8 weeks of starting and periodically during long-term use. Other warnings cover high blood pressure, heart failure, kidney damage, severe skin reactions and anemia. Stomach upset, headache and dizziness are common side effects.

Voltaren gel went over the counter in 2020, and 1 percent gels are now sold without a prescription: they are for arthritis pain in the hand, wrist, elbow, foot, ankle or knee, four times a day for up to 21 days unless a doctor directs otherwise, not for strains, sprains, bruises or sports injuries, with those under 18 told to ask a doctor. Prescription topicals include a 1.5 percent solution for the signs and symptoms of knee osteoarthritis, a 2 percent solution for knee osteoarthritis pain, Flector and Licart patches for minor strains, sprains and bruises from age 6, and a 3 percent gel for actinic keratoses. NSAIDs used from about 20 weeks of pregnancy can harm the unborn baby’s kidneys, and from about 30 weeks can close a fetal blood vessel too early; the over-the-counter label says not to use it from 20 weeks unless a doctor directs. Arthrotec, which adds misoprostol to protect the stomach, is contraindicated in pregnancy.

Taking Diclofenac

How to take it

Empty a Cambia packet into 1 to 2 ounces (30 to 60 mL) of water only and drink it at once; food may make it work less well. Apply gels and solutions to clean, dry, intact skin with no heat or bandage over them, measuring the over-the-counter gel on its dosing card. Wear a patch on the most painful area (Flector twice a day, Licart once a day), but not in the bath or shower.

If you miss a dose

Cambia is taken only as needed for a migraine attack. For other forms, take or apply a missed dose as soon as you remember, unless the next is nearly due; then skip it. Do not take or apply extra to make up for it.

Storage

At room temperature, tightly closed, out of reach of children; keep the gel and topical solutions from freezing. Fold used patches sticky sides together and discard them out of reach of children and pets. Use a take-back program rather than flushing.

Interactions to know about

Do not combine it with other NSAIDs or pain-relieving doses of aspirin. Blood thinners, SSRIs and SNRIs add to bleeding risk. It can weaken ACE inhibitors, ARBs, beta blockers and diuretics and add to lithium, methotrexate, digoxin and cyclosporine problems. CYP2C9 inhibitors such as voriconazole raise its levels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Diclofenac differs from pharmacy to pharmacy

Because the forms are not interchangeable, a pharmacist fills only the form and strength written. Zipsor, Cambia and Arthrotec have rated generics, so a prescription that names one of these brands and blocks substitution is priced as a brand.

Flector and Licart patches have no generic, and the 1 percent gel is sold over the counter, outside a prescription quote.

Ways to pay less for Diclofenac without insurance

• Ask for a rated generic, and check that the prescription does not name a brand only.
• For hand or knee arthritis pain, ask the prescriber whether the over-the-counter 1 percent gel would suit you.
• Ask whether diclofenac tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Diclofenac

1. 1.Is my prescription for diclofenac sodium, diclofenac potassium or another form?
2. 2.Is it safe with my heart, kidney, liver or blood pressure conditions?
3. 3.Can I use a diclofenac gel or patch while I take tablets?
4. 4.Which stomach, liver or bleeding symptoms mean I should stop it and get help?

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