Diclofenac for Arthritis – What You Need to Know

Voltaren (diclofenac) belongs to the class of drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs). NSAIDs are commonly prescribed to treat arthritis. The brand name version, Voltaren, which was manufactured by Novartis, was FDA-approved in 1988.

Diclofenac is available as an immediate-release tablet, liquid-filled capsule, and an extended-release tablet taken orally (by mouth). Diclofenac immediate-release tablets and capsules are available in 50 mg and 75 mg strength. Diclofenac extended-release tablets are available in 100 mg strength.

Diclofenac is prescribed for relief of the signs and symptoms of osteoarthritis, relief of the signs and symptoms of rheumatoid arthritis, and for acute or long-term use to relieve signs and symptoms of ankylosing spondylitis.

Diclofenac, like all other NSAIDs, have anti-inflammatory and analgesic (pain-relieving) properties. The mechanism of action is thought to be related to the inhibition of prostaglandins which are involved in inflammation.

Usually, directions suggest taking NSAIDs with food to decrease the risk of gastrointestinal problems, but diclofenac is available as an enteric-coated tablet. The enteric coating helps protect the stomach. Therefore, taking diclofenac with food is not mandatory.

People are advised to take the lowest effective dose of diclofenac for the shortest duration possible. Some people with arthritis will be treated with the drug longterm because various types of arthritis are chronic diseases with no known cure. Your doctor will adjust dose and frequency to meet your needs. The recommended dose for osteoarthritis is 100-150 mg per day taken as 50 mg two or three times a day, or 75 mg twice a day. The recommended dose for rheumatoid arthritis is 150-200 mg per day, taken as 50 mg three or four times a day, or 75 mg twice a day. For ankylosing spondylitis, 100-125 mg per day is recommended, taken as 25 mg four times a day with an additional 25 mg dose at bedtime if needed.

Common side effects associated with diclofenac include diarrhea, constipation, gas or bloating, headache, dizziness, and ringing in the ears. If these side effects are bothersome and do not go away, call your doctor.

Side effects that may be more severe and warrant an immediate call to your doctor include: weight gain, excessive fatigue, lack of energy, nausea, loss of appetite, itching, stomach pain (especially upper right part), skin or eye yellowing, flu-like symptoms, fever, rash, hives, swelling of eyes face, tongue, lips, throat, or upper/lower extremities, difficulty breathing, difficulty swallowing, hoarseness, pale skin, rapid heartbeat, cloudy or discolored urine, back pain, or painful urination. The side effects listed are not exclusive. If you have any unusual occurrence while taking diclofenac, call your doctor.

Voltaren gel may also have adverse reactions.

Diclofenac, as is the case with all non-aspirin NSAIDs, may be associated with increased risk of serious cardiovascular side effects, such as heart attack or stroke, which may result in hospitalization or death. Diclofenac, like all NSAIDs, can cause gastrointestinal side effects, such as bleeding and ulcers. Gastrointestinal complications can occur without warning. Rarely, diclofenac can be associated with serious skin side effects, including Stevens-Johnson syndrome, exfoliative dermatitis, and Toxic Epidermal Necrolysis which can result in hospitalization and death. Anaphylactic reactions are also possible. You should be aware that serious side effects are possible and be aware of unusual symptoms.

Be sure to tell your doctor about all of the drugs and supplements that you take. Drug interactions can occur with diclofenac and the following drugs: aspirin, methotrexate, cyclosporine, ACE inhibitors, furosemide, lithium, warfarin, and CYP2C9 inhibitors.

Are There Special Instructions for Pregnant or Nursing Women?

Use of diclofenac is not recommended during pregnancy or while nursing.